Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally per...
Mueller, Jerel K; Grigsby, Erinn M; Prevosto, Vincent; Petraglia, Frank W; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V; Sommer, Marc A; Egner, Tobias; Platt, Michael L; Grill, Warren M
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report new methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in awake monkeys (Macaca mulatta). We recorded action potentials within ∼1 ms after 0.4-ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared with sham stimulation. This methodology is compatible with standard equipment in primate laboratories, allowing easy implementation. Application of these tools will facilitate the refinement of next generation TMS devices, experiments and treatment protocols.
Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in intact, awake monkeys (Macaca mulatta). We recorded action potentials within ~1 ms after 0.4 ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared to sham stimulation. The methodology is compatible with standard equipment in primate laboratories, allowing for easy implementation. Application of these new tools will facilitate the refinement of next generation TMS devices, experiments, and treatment protocols. PMID:24974797
Starosta, Sarah; Stüttgen, Maik C; Güntürkün, Onur
While the subject of learning has attracted immense interest from both behavioral and neural scientists, only relatively few investigators have observed single-neuron activity while animals are acquiring an operantly conditioned response, or when that response is extinguished. But even in these cases, observation periods usually encompass only a single stage of learning, i.e. acquisition or extinction, but not both (exceptions include protocols employing reversal learning; see Bingman et al.(1) for an example). However, acquisition and extinction entail different learning mechanisms and are therefore expected to be accompanied by different types and/or loci of neural plasticity. Accordingly, we developed a behavioral paradigm which institutes three stages of learning in a single behavioral session and which is well suited for the simultaneous recording of single neurons' action potentials. Animals are trained on a single-interval forced choice task which requires mapping each of two possible choice responses to the presentation of different novel visual stimuli (acquisition). After having reached a predefined performance criterion, one of the two choice responses is no longer reinforced (extinction). Following a certain decrement in performance level, correct responses are reinforced again (reacquisition). By using a new set of stimuli in every session, animals can undergo the acquisition-extinction-reacquisition process repeatedly. Because all three stages of learning occur in a single behavioral session, the paradigm is ideal for the simultaneous observation of the spiking output of multiple single neurons. We use pigeons as model systems, but the task can easily be adapted to any other species capable of conditioned discrimination learning.
Colvin, Robert A; Lai, Barry; Holmes, William R; Lee, Daewoo
The purpose of this study was to demonstrate how single cell quantitative and subcellular metallomics inform us about both the spatial distribution and cellular mechanisms of metal buffering and homeostasis in primary cultured neurons from embryonic rat brain, which are often used as models of human disease involving metal dyshomeostasis. The present studies utilized synchrotron radiation X-ray fluorescence (SRXRF) and focused primarily on zinc and iron, two abundant metals in neurons that have been implicated in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. Total single cell contents for calcium, iron, zinc, copper, manganese, and nickel were determined. Resting steady state zinc showed a diffuse distribution in both soma and processes, best defined by the mass profile of the neuron with an enrichment in the nucleus compared with the cytoplasm. Zinc buffering and homeostasis was studied using two modes of cellular zinc loading - transporter and ionophore (pyrithione) mediated. Single neuron zinc contents were shown to statistically significantly increase by either loading method - ionophore: 160 million to 7 billion; transporter 160 million to 280 million atoms per neuronal soma. The newly acquired and buffered zinc still showed a diffuse distribution. Soma and processes have about equal abilities to take up zinc via transporter mediated pathways. Copper levels are distributed diffusely as well, but are relatively higher in the processes relative to zinc levels. Prior studies have observed iron puncta in certain cell types, but others have not. In the present study, iron puncta were characterized in several primary neuronal types. The results show that iron puncta could be found in all neuronal types studied and can account for up to 50% of the total steady state content of iron in neuronal soma. Although other metals can be present in iron puncta, they are predominantly iron containing and do not appear to be
McKenna, Thomas M; Zornetzer, Steven F
This book contains twenty-two original contributions that provide a comprehensive overview of computational approaches to understanding a single neuron structure. The focus on cellular-level processes is twofold. From a computational neuroscience perspective, a thorough understanding of the information processing performed by single neurons leads to an understanding of circuit- and systems-level activity. From the standpoint of artificial neural networks (ANNs), a single real neuron is as complex an operational unit as an entire ANN, and formalizing the complex computations performed by real n
Marquardt, Torsten; Stange, Annette; Pecka, Michael; Grothe, Benedikt; McAlpine, David
Recently, with the use of an amplitude-modulated binaural beat (AMBB), in which sound amplitude and interaural-phase difference (IPD) were modulated with a fixed mutual relationship (Dietz et al. 2013b), we demonstrated that the human auditory system uses interaural timing differences in the temporal fine structure of modulated sounds only during the rising portion of each modulation cycle. However, the degree to which peripheral or central mechanisms contribute to the observed strong dominance of the rising slope remains to be determined. Here, by recording responses of single neurons in the medial superior olive (MSO) of anesthetized gerbils and in the inferior colliculus (IC) of anesthetized guinea pigs to AMBBs, we report a correlation between the position within the amplitude-modulation (AM) cycle generating the maximum response rate and the position at which the instantaneous IPD dominates the total neural response. The IPD during the rising segment dominates the total response in 78% of MSO neurons and 69% of IC neurons, with responses of the remaining neurons predominantly coding the IPD around the modulation maximum. The observed diversity of dominance regions within the AM cycle, especially in the IC, and its comparison with the human behavioral data suggest that only the subpopulation of neurons with rising slope dominance codes the sound-source location in complex listening conditions. A comparison of two models to account for the data suggests that emphasis on IPDs during the rising slope of the AM cycle depends on adaptation processes occurring before binaural interaction. PMID:24554782
Fujiyama, Fumino; Nakano, Takashi; Matsuda, Wakoto; Furuta, Takahiro; Udagawa, Jun; Kaneko, Takeshi
The external globus pallidus (GP) is known as a relay nucleus of the indirect pathway of the basal ganglia. Recent studies in dopamine-depleted and healthy rats indicate that the GP comprises two main types of pallidofugal neurons: the so-called "prototypic" and "arkypallidal" neurons. However, the reconstruction of complete arkypallidal neurons in healthy rats has not been reported. Here we visualized the entire axonal arborization of four single arkypallidal neurons and six single prototypic neurons in rat brain using labeling with a viral vector expressing membrane-targeted green fluorescent protein and examined the distribution of axon boutons in the target nuclei. Results revealed that not only the arkypallidal neurons but nearly all of the prototypic neurons projected to the striatum with numerous axon varicosities. Thus, the striatum is a major target nucleus for pallidal neurons. Arkypallidal and prototypic GP neurons located in the calbindin-positive and calbindin-negative regions mainly projected to the corresponding positive and negative regions in the striatum. Because the GP and striatum calbindin staining patterns reflect the topographic organization of the striatopallidal projection, the striatal neurons in the sensorimotor and associative regions constitute the reciprocal connection with the GP neurons in the corresponding regions.
Full Text Available Recent developments of multielectrode technology made it possible to measure the extracellular potential generated in the neural tissue with spatial precision on the order of tens of micrometers and on submillisecond time scale. Combining such measurements with imaging of single neurons within the studied tissue opens up new experimental possibilities for estimating distribution of current sources along a dendritic tree. In this work we show that if we are able to relate part of the recording of extracellular potential to a specific cell of known morphology we can estimate the spatiotemporal distribution of transmembrane currents along it. We present here an extension of the kernel CSD method (Potworowski et al., 2012 applicable in such case. We test it on several model neurons of progressively complicated morphologies from ball-and-stick to realistic, up to analysis of simulated neuron activity embedded in a substantial working network (Traub et al, 2005. We discuss the caveats and possibilities of this new approach.
Hutt, Axel; Buhry, Laure
Anaesthetic agents are known to affect extra-synaptic GABAergic receptors, which induce tonic inhibitory currents. Since these receptors are very sensitive to small concentrations of agents, they are supposed to play an important role in the underlying neural mechanism of general anaesthesia. Moreover anaesthetic agents modulate the encephalographic activity (EEG) of subjects and hence show an effect on neural populations. To understand better the tonic inhibition effect in single neurons on neural populations and hence how it affects the EEG, the work considers single neurons and neural populations in a steady-state and studies numerically and analytically the modulation of their firing rate and nonlinear gain with respect to different levels of tonic inhibition. We consider populations of both type-I (Leaky Integrate-and-Fire model) and type-II (Morris-Lecar model) neurons. To bridge the single neuron description to the population description analytically, a recently proposed statistical approach is employed which allows to derive new analytical expressions for the population firing rate for type-I neurons. In addition, the work shows the derivation of a novel transfer function for type-I neurons as considered in neural mass models and studies briefly the interaction of synaptic and extra-synaptic inhibition. We reveal a strong subtractive and divisive effect of tonic inhibition in type-I neurons, i.e. a shift of the firing rate to higher excitation levels accompanied by a change of the nonlinear gain. Tonic inhibition shortens the excitation window of type-II neurons and their populations while maintaining the nonlinear gain. The gained results are interpreted in the context of recent experimental findings under propofol-induced anaesthesia.
Newhoff, Morgan; Treiman, David M; Smith, Kris A; Steinmetz, Peter N
Well-documented differences in the psychology and behavior of men and women have spurred extensive exploration of gender's role within the brain, particularly regarding emotional processing. While neuroanatomical studies clearly show differences between the sexes, the functional effects of these differences are less understood. Neuroimaging studies have shown inconsistent locations and magnitudes of gender differences in brain hemodynamic responses to emotion. To better understand the neurophysiology of these gender differences, we analyzed recordings of single neuron activity in the human brain as subjects of both genders viewed emotional expressions. This study included recordings of single-neuron activity of 14 (6 male) epileptic patients in four brain areas: amygdala (236 neurons), hippocampus (n = 270), anterior cingulate cortex (n = 256), and ventromedial prefrontal cortex (n = 174). Neural activity was recorded while participants viewed a series of avatar male faces portraying positive, negative or neutral expressions. Significant gender differences were found in the left amygdala, where 23% (n = 15∕66) of neurons in men were significantly affected by facial emotion, vs. 8% (n = 6∕76) of neurons in women. A Fisher's exact test comparing the two ratios found a highly significant difference between the two (p differences between genders at the single-neuron level in the human amygdala. These differences may reflect gender-based distinctions in evolved capacities for emotional processing and also demonstrate the importance of including subject gender as an independent factor in future studies of emotional processing by single neurons in the human amygdala.
Fu, Tian-Ming; Hong, Guosong; Zhou, Tao; Schuhmann, Thomas G; Viveros, Robert D; Lieber, Charles M
Stable in vivo mapping and modulation of the same neurons and brain circuits over extended periods is critical to both neuroscience and medicine. Current electrical implants offer single-neuron spatiotemporal resolution but are limited by such factors as relative shear motion and chronic immune responses during long-term recording. To overcome these limitations, we developed a chronic in vivo recording and stimulation platform based on flexible mesh electronics, and we demonstrated stable multiplexed local field potentials and single-unit recordings in mouse brains for at least 8 months without probe repositioning. Properties of acquired signals suggest robust tracking of the same neurons over this period. This recording and stimulation platform allowed us to evoke stable single-neuron responses to chronic electrical stimulation and to carry out longitudinal studies of brain aging in freely behaving mice. Such advantages could open up future studies in mapping and modulating changes associated with learning, aging and neurodegenerative diseases.
Full Text Available Well-documented differences in the psychology and behavior of men and women have spurred extensive exploration of gender's role within the brain, particularly regarding emotional processing. While neuroanatomical studies clearly show differences between the sexes, the functional effects of these differences are less understood. Neuroimaging studies have shown inconsistent locations and magnitudes of gender differences in brain hemodynamic responses to emotion. To better understand the neurophysiology of these gender differences, we analyzed recordings of single neuron activity in the human brain as subjects of both genders viewed emotional expressions.This study included recordings of single-neuron activity of 14 (6 male epileptic patients in four brain areas: amygdala (236 neurons, hippocampus (n=270, anterior cingulate cortex (n=256, and ventromedial prefrontal cortex (n=174. Neural activity was recorded while participants viewed a series of avatar male faces portraying positive, negative or neutral expressions.Significant gender differences were found in the left amygdala, where 23% (n=15/66 of neurons in men were significantly affected by facial emotion, versus 8% (n=6/76 of neurons in women. A Fisher's exact test comparing the two ratios found a highly significant difference between the two (p<0.01. These results show specific differences between genders at the single-neuron level in the human amygdala. These differences may reflect gender-based distinctions in evolved capacities for emotional processing and also demonstrate the importance of including subject gender as an independent factor in future studies of emotional processing by single neurons in the human amygdala.
Zamora, Leona; Corina, David; Ojemann, George
The Working Memory model of human memory, first introduced by Baddeley and Hitch (1974), has been one of the most influential psychological constructs in cognitive psychology and human neuroscience. However the neuronal correlates of core components of this model have yet to be fully elucidated. Here we present data from two studies where human temporal cortical single neuron activity was recorded during tasks differentially affecting the maintenance component of verbal working memory. In Study One we vary the presence or absence of distracting items for the entire period of memory storage. In Study Two we vary the duration of storage so that distractors filled all, or only one-third of the time the memory was stored. Extracellular single neuron recordings were obtained from 36 subjects undergoing awake temporal lobe resections for epilepsy, 25 in Study one, 11 in Study two. Recordings were obtained from a total of 166 lateral temporal cortex neurons during performance of one of these two tasks, 86 study one, 80 study two. Significant changes in activity with distractor manipulation were present in 74 of these neurons (45%), 38 Study one, 36 Study two. In 48 (65%) of those there was increased activity during the period when distracting items were absent, 26 Study One, 22 Study Two. The magnitude of this increase was greater for Study One, 47.6%, than Study Two, 8.1%, paralleling the reduction in memory errors in the absence of distracters, for Study One of 70.3%, Study Two 26.3% These findings establish that human lateral temporal cortex is part of the neural system for working memory, with activity during maintenance of that memory that parallels performance, suggesting it represents active rehearsal. In 31 of these neurons (65%) this activity was an extension of that during working memory encoding that differed significantly from the neural processes recorded during overt and silent language tasks without a recent memory component, 17 Study one, 14 Study two
Zamora, Leona; Corina, David; Ojemann, George
The Working Memory model of human memory, first introduced by Baddeley and Hitch (1974), has been one of the most influential psychological constructs in cognitive psychology and human neuroscience. However the neuronal correlates of core components of this model have yet to be fully elucidated. Here we present data from two studies where human temporal cortical single neuron activity was recorded during tasks differentially affecting the maintenance component of verbal working memory. In Study One we vary the presence or absence of distracting items for the entire period of memory storage. In Study Two we vary the duration of storage so that distractors filled all, or only one-third of the time the memory was stored. Extracellular single neuron recordings were obtained from 36 subjects undergoing awake temporal lobe resections for epilepsy, 25 in Study one, 11 in Study two. Recordings were obtained from a total of 166 lateral temporal cortex neurons during performance of one of these two tasks, 86 study one, 80 study two. Significant changes in activity with distractor manipulation were present in 74 of these neurons (45%), 38 Study one, 36 Study two. In 48 (65%) of those there was increased activity during the period when distracting items were absent, 26 Study One, 22 Study Two. The magnitude of this increase was greater for Study One, 47.6%, than Study Two, 8.1%, paralleling the reduction in memory errors in the absence of distracters, for Study One of 70.3%, Study Two 26.3% These findings establish that human lateral temporal cortex is part of the neural system for working memory, with activity during maintenance of that memory that parallels performance, suggesting it represents active rehearsal. In 31 of these neurons (65%) this activity was an extension of that during working memory encoding that differed significantly from the neural processes recorded during overt and silent language tasks without a recent memory component, 17 Study one, 14 Study two
Zandt, B.; Stigen, Tyler; ten Haken, Bernard; Netoff, Theoden; van Putten, Michel Johannes Antonius Maria
We studied single neuron dynamics during anoxic depolarizations, which are often observed in cases of neuronal energy depletion. Anoxic and similar depolarizations play an important role in several pathologies, notably stroke, migraine, and epilepsy. One of the effects of energy depletion was
Zhu, Hongying; Zou, Guichang; Wang, Ning; Zhuang, Meihui; Xiong, Wei; Huang, Guangming
The use of single-cell assays has emerged as a cutting-edge technique during the past decade. Although single-cell mass spectrometry (MS) has recently achieved remarkable results, deep biological insights have not yet been obtained, probably because of various technical issues, including the unavoidable use of matrices, the inability to maintain cell viability, low throughput because of sample pretreatment, and the lack of recordings of cell physiological activities from the same cell. In this study, we describe a patch clamp/MS-based platform that enables the sensitive, rapid, and in situ chemical profiling of single living neurons. This approach integrates modified patch clamp technique and modified MS measurements to directly collect and detect nanoliter-scale samples from the cytoplasm of single neurons in mice brain slices. Abundant possible cytoplasmic constituents were detected in a single neuron at a relatively fast rate, and over 50 metabolites were identified in this study. The advantages of direct, rapid, and in situ sampling and analysis enabled us to measure the biological activities of the cytoplasmic constituents in a single neuron, including comparing neuron types by cytoplasmic chemical constituents; observing changes in constituent concentrations as the physiological conditions, such as age, vary; and identifying the metabolic pathways of small molecules.
Wallis, J D; Anderson, K C; Miller, E K
The ability to abstract principles or rules from direct experience allows behaviour to extend beyond specific circumstances to general situations. For example, we learn the 'rules' for restaurant dining from specific experiences and can then apply them in new restaurants. The use of such rules is thought to depend on the prefrontal cortex (PFC) because its damage often results in difficulty in following rules. Here we explore its neural basis by recording from single neurons in the PFC of monkeys trained to use two abstract rules. They were required to indicate whether two successively presented pictures were the same or different depending on which rule was currently in effect. The monkeys performed this task with new pictures, thus showing that they had learned two general principles that could be applied to stimuli that they had not yet experienced. The most prevalent neuronal activity observed in the PFC reflected the coding of these abstract rules.
Kuramoto, Eriko; Pan, Shixiu; Furuta, Takahiro; Tanaka, Yasuhiro R; Iwai, Haruki; Yamanaka, Atsushi; Ohno, Sachi; Kaneko, Takeshi; Goto, Tetsuya; Hioki, Hiroyuki
The prefrontal cortex has an important role in a variety of cognitive and executive processes, and is generally defined by its reciprocal connections with the mediodorsal thalamic nucleus (MD). The rat MD is mainly subdivided into three segments, the medial (MDm), central (MDc), and lateral (MDl) divisions, on the basis of the cytoarchitecture and chemoarchitecture. The MD segments are known to topographically project to multiple prefrontal areas at the population level: the MDm mainly to the prelimbic, infralimbic, and agranular insular areas; the MDc to the orbital and agranular insular areas; and the MDl to the prelimbic and anterior cingulate areas. However, it is unknown whether individual MD neurons project to single or multiple prefrontal cortical areas. In the present study, we visualized individual MD neurons with Sindbis virus vectors, and reconstructed whole structures of MD neurons. While the main cortical projection targets of MDm, MDc, and MDl neurons were generally consistent with those of previous results, it was found that individual MD neurons sent their axon fibers to multiple prefrontal areas, and displayed various projection patterns in the target areas. Furthermore, the axons of single MD neurons were not homogeneously spread, but were rather distributed to form patchy axon arbors approximately 1 mm in diameter. The multiple-area projections and patchy axon arbors of single MD neurons might be able to coactivate cortical neuron groups in distant prefrontal areas simultaneously. Furthermore, considerable heterogeneity of the projection patterns is likely, to recruit the different sets of cortical neurons, and thus contributes to a variety of prefrontal functions. J. Comp. Neurol. 525:166-185, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Jenison, Rick L; Rangel, Antonio; Oya, Hiroyuki; Kawasaki, Hiroto; Howard, Matthew A
A growing consensus suggests that the brain makes simple choices by assigning values to the stimuli under consideration and then comparing these values to make a decision. However, the network involved in computing the values has not yet been fully characterized. Here, we investigated whether the human amygdala plays a role in the computation of stimulus values at the time of decision making. We recorded single neuron activity from the amygdala of awake patients while they made simple purchase decisions over food items. We found 16 amygdala neurons, located primarily in the basolateral nucleus that responded linearly to the values assigned to individual items.
Parkins, C W; Colombo, J
Single auditory-nerve neuron thresholds were studied in sensory-deafened squirrel monkeys to determine the effects of electrical stimulus shape and frequency on single-neuron thresholds. Frequency was separated into its components, pulse width and pulse rate, which were analyzed separately. Square and sinusoidal pulse shapes were compared. There were no or questionably significant threshold differences in charge per phase between sinusoidal and square pulses of the same pulse width. There was a small (less than 0.5 dB) but significant threshold advantage for 200 microseconds/phase pulses delivered at low pulse rates (156 pps) compared to higher pulse rates (625 pps and 2500 pps). Pulse width was demonstrated to be the prime determinant of single-neuron threshold, resulting in strength-duration curves similar to other mammalian myelinated neurons, but with longer chronaxies. The most efficient electrical stimulus pulse width to use for cochlear implant stimulation was determined to be 100 microseconds/phase. This pulse width delivers the lowest charge/phase at threshold. The single-neuron strength-duration curves were compared to strength-duration curves of a computer model based on the specific anatomy of auditory-nerve neurons. The membrane capacitance and resulting chronaxie of the model can be varied by altering the length of the unmyelinated termination of the neuron, representing the unmyelinated portion of the neuron between the habenula perforata and the hair cell. This unmyelinated segment of the auditory-nerve neuron may be subject to aminoglycoside damage. Simulating a 10 micron unmyelinated termination for this model neuron produces a strength-duration curve that closely fits the single-neuron data obtained from aminoglycoside deafened animals. Both the model and the single-neuron strength-duration curves differ significantly from behavioral threshold data obtained from monkeys and humans with cochlear implants. This discrepancy can best be explained by
Rule, Michael E.; Vargas-Irwin, Carlos; Donoghue, John P.; Truccolo, Wilson
Understanding the sources of variability in single-neuron spiking responses is an important open problem for the theory of neural coding. This variability is thought to result primarily from spontaneous collective dynamics in neuronal networks. Here, we investigate how well collective dynamics reflected in motor cortex local field potentials (LFPs) can account for spiking variability during motor behavior. Neural activity was recorded via microelectrode arrays implanted in ventral and dorsal premotor and primary motor cortices of non-human primates performing naturalistic 3-D reaching and grasping actions. Point process models were used to quantify how well LFP features accounted for spiking variability not explained by the measured 3-D reach and grasp kinematics. LFP features included the instantaneous magnitude, phase and analytic-signal components of narrow band-pass filtered (δ,θ,α,β) LFPs, and analytic signal and amplitude envelope features in higher-frequency bands. Multiband LFP features predicted single-neuron spiking (1ms resolution) with substantial accuracy as assessed via ROC analysis. Notably, however, models including both LFP and kinematics features displayed marginal improvement over kinematics-only models. Furthermore, the small predictive information added by LFP features to kinematic models was redundant to information available in fast-timescale (spiking history. Overall, information in multiband LFP features, although predictive of single-neuron spiking during movement execution, was redundant to information available in movement parameters and spiking history. Our findings suggest that, during movement execution, collective dynamics reflected in motor cortex LFPs primarily relate to sensorimotor processes directly controlling movement output, adding little explanatory power to variability not accounted by movement parameters. PMID:26157365
Martin, Kevan A C; Schröder, Sylvia
The local field potential (LFP) is thought to reflect a temporal reference for neuronal spiking, which may facilitate information coding and orchestrate the communication between neural populations. To explore this proposed role, we recorded the LFP and simultaneously the spike activity of one to three nearby neurons in V1 of anesthetized cats during the presentation of drifting sinusoidal gratings, binary dense noise stimuli, and natural movies. In all stimulus conditions and during spontaneous activity, the average LFP power at frequencies >20 Hz was higher when neurons were spiking versus not spiking. The spikes were weakly but significantly phase locked to all frequencies of the LFP. The average spike phase of the LFP was stable across high and low levels of LFP power, but the strength of phase locking at low frequencies (≤10 Hz) increased with increasing LFP power. In a next step, we studied how strong stimulus responses of single neurons are reflected in the LFP and the LFP-spike relationship. We found that LFP power was slightly increased and phase locking was slightly stronger during strong compared with weak stimulus-locked responses. In summary, the coupling strength between high frequencies of the LFP and spikes was not strongly modulated by LFP power, which is thought to reflect spiking synchrony, nor was it strongly influenced by how strongly the neuron was driven by the stimulus. Furthermore, a comparison between neighboring neurons showed no clustering of preferred LFP phase. We argue that hypotheses on the relevance of phase locking in their current form are inconsistent with our findings. Copyright © 2016 the authors 0270-6474/16/362494-09$15.00/0.
Baker, Christa A; Ma, Lisa; Casareale, Chelsea R; Carlson, Bruce A
In many sensory pathways, central neurons serve as temporal filters for timing patterns in communication signals. However, how a population of neurons with diverse temporal filtering properties codes for natural variation in communication signals is unknown. Here we addressed this question in the weakly electric fish Brienomyrus brachyistius, which varies the time intervals between successive electric organ discharges to communicate. These fish produce an individually stereotyped signal called a scallop, which consists of a distinctive temporal pattern of ∼8-12 electric pulses. We manipulated the temporal structure of natural scallops during behavioral playback and in vivo electrophysiology experiments to probe the temporal sensitivity of scallop encoding and recognition. We found that presenting time-reversed, randomized, or jittered scallops increased behavioral response thresholds, demonstrating that fish's electric signaling behavior was sensitive to the precise temporal structure of scallops. Next, using in vivo intracellular recordings and discriminant function analysis, we found that the responses of interval-selective midbrain neurons were also sensitive to the precise temporal structure of scallops. Subthreshold changes in membrane potential recorded from single neurons discriminated natural scallops from time-reversed, randomized, and jittered sequences. Pooling the responses of multiple neurons improved the discriminability of natural sequences from temporally manipulated sequences. Finally, we found that single-neuron responses were sensitive to interindividual variation in scallop sequences, raising the question of whether fish may analyze scallop structure to gain information about the sender. Collectively, these results demonstrate that a population of interval-selective neurons can encode behaviorally relevant temporal patterns with millisecond precision. The timing patterns of action potentials, or spikes, play important roles in representing
Wang, Ting-Yuan; Chen, Nan-Yow; He, Guan-Wei; Wang, Guo-Tzau; Shih, Chi-Tin; Chiang, Ann-Shyn
Effective 3D visualization is essential for connectomics analysis, where the number of neural images easily reaches over tens of thousands. A formidable challenge is to simultaneously visualize a large number of distinguishable single-neuron images, with reasonable processing time and memory for file management and 3D rendering. In the present study, we proposed an algorithm named "Kaleido" that can visualize up to at least ten thousand single neurons from the Drosophila brain using only a fraction of the memory traditionally required, without increasing computing time. Adding more brain neurons increases memory only nominally. Importantly, Kaleido maximizes color contrast between neighboring neurons so that individual neurons can be easily distinguished. Colors can also be assigned to neurons based on biological relevance, such as gene expression, neurotransmitters, and/or development history. For cross-lab examination, the identity of every neuron is retrievable from the displayed image. To demonstrate the effectiveness and tractability of the method, we applied Kaleido to visualize the 10,000 Drosophila brain neurons obtained from the FlyCircuit database ( http://www.flycircuit.tw/modules.php?name=kaleido ). Thus, Kaleido visualization requires only sensible computer memory for manual examination of big connectomics data.
1 Some basic neurophysiology 4 The neuron 1. 1 4 1. 1. 1 The axon 7 1. 1. 2 The synapse 9 12 1. 1. 3 The soma 1. 1. 4 The dendrites 13 13 1. 2 Types of neurons 2 Signals in the nervous system 14 2. 1 Action potentials as point events - point processes in the nervous system 15 18 2. 2 Spontaneous activi~ in neurons 3 Stochastic modelling of single neuron spike trains 19 3. 1 Characteristics of a neuron spike train 19 3. 2 The mathematical neuron 23 4 Superposition models 26 4. 1 superposition of renewal processes 26 4. 2 Superposition of stationary point processe- limiting behaviour 34 4. 2. 1 Palm functions 35 4. 2. 2 Asymptotic behaviour of n stationary point processes superposed 36 4. 3 Superposition models of neuron spike trains 37 4. 3. 1 Model 4. 1 39 4. 3. 2 Model 4. 2 - A superposition model with 40 two input channels 40 4. 3. 3 Model 4. 3 4. 4 Discussion 41 43 5 Deletion models 5. 1 Deletion models with 1nd~endent interaction of excitatory and inhibitory sequences 44 VI 5. 1. 1 Model 5. 1 The basic de...
Closas, Pau; Guillamon, Antoni
This paper deals with the problem of inferring the signals and parameters that cause neural activity to occur. The ultimate challenge being to unveil brain's connectivity, here we focus on a microscopic vision of the problem, where single neurons (potentially connected to a network of peers) are at the core of our study. The sole observation available are noisy, sampled voltage traces obtained from intracellular recordings. We design algorithms and inference methods using the tools provided by stochastic filtering that allow a probabilistic interpretation and treatment of the problem. Using particle filtering, we are able to reconstruct traces of voltages and estimate the time course of auxiliary variables. By extending the algorithm, through PMCMC methodology, we are able to estimate hidden physiological parameters as well, like intrinsic conductances or reversal potentials. Last, but not least, the method is applied to estimate synaptic conductances arriving at a target cell, thus reconstructing the synaptic excitatory/inhibitory input traces. Notably, the performance of these estimations achieve the theoretical lower bounds even in spiking regimes.
Kashiwayanagi, M; Shimano, K; Kurihara, K
The responses of single bullfrog olfactory neurons to various odorants were measured with the whole-cell patch clamp which offers direct information on cellular events and with the ciliary recording technique to obtain stable quantitative data from many neurons. A large portion of single olfactory neurons (about 64% and 79% in the whole-cell recording and in the ciliary recording, respectively) responded to many odorants with quite diverse molecular structures, including both odorants previously indicated to be cAMP-dependent (increasing) and independent odorants. One odorant elicited a response in many cells; e.g. hedione and citralva elicited the response in 100% and 92% of total neurons examined with the ciliary recording technique. To confirm that a single neuron carries different receptors or transduction pathways, the cross-adaptation technique was applied to single neurons. Application of hedione to a single neuron after desensitization of the current in response to lyral or citralva induced an inward current with a similar magnitude to that applied alone. It was suggested that most single olfactory neurons carry multiple receptors and at least dual transduction pathways.
Hage, Steffen R; Nieder, Andreas
Complex audio-vocal integration systems depend on a strong interconnection between the auditory and the vocal motor system. To gain cognitive control over audio-vocal interaction during vocal motor control, the PFC needs to be involved. Neurons in the ventrolateral PFC (VLPFC) have been shown to separately encode the sensory perceptions and motor production of vocalizations. It is unknown, however, whether single neurons in the PFC reflect audio-vocal interactions. We therefore recorded single-unit activity in the VLPFC of rhesus monkeys (Macaca mulatta) while they produced vocalizations on command or passively listened to monkey calls. We found that 12% of randomly selected neurons in VLPFC modulated their discharge rate in response to acoustic stimulation with species-specific calls. Almost three-fourths of these auditory neurons showed an additional modulation of their discharge rates either before and/or during the monkeys' motor production of vocalization. Based on these audio-vocal interactions, the VLPFC might be well positioned to combine higher order auditory processing with cognitive control of the vocal motor output. Such audio-vocal integration processes in the VLPFC might constitute a precursor for the evolution of complex learned audio-vocal integration systems, ultimately giving rise to human speech. Copyright © 2015 the authors 0270-6474/15/357030-11$15.00/0.
Villagran-Vargas, Edgar; Rodríguez-Sosa, Leonardo; Hustert, Reinhold; Blicher, Andreas; Laub, Katrine; Heimburg, Thomas
In this work, we analyzed the interpulse interval (IPI) of doublets and triplets in single neurons of three biological models. Pulse trains with two or three spikes originate from the process of sensory mechanotransduction in neurons of the locust femoral nerve, as well as through spontaneous activity both in the abdominal motor neurons and the caudal photoreceptor of the crayfish. We show that the IPI for successive low-frequency single action potentials, as recorded with two electrodes at two different points along a nerve axon, remains constant. On the other hand, IPI in doublets either remains constant, increases or decreases by up to about 3 ms as the pair propagates. When IPI increases, the succeeding pulse travels at a slower speed than the preceding one. When IPI is reduced, the succeeding pulse travels faster than the preceding one and may exceed the normal value for the specific neuron. In both cases, IPI increase and reduction, the speed of the preceding pulse differs slightly from the normal value, therefore the two pulses travel at different speeds in the same nerve axon. On the basis of our results, we may state that the effect of attraction or repulsion in doublets suggests a tendency of the spikes to reach a stable configuration. We strongly suggest that the change in IPI during spike propagation of doublets opens up a whole new realm of possibilities for neural coding and may have major implications for understanding information processing in nervous systems. Copyright © 2012 Wiley Periodicals, Inc.
Plakke, Bethany; Diltz, Mark D; Romanski, Lizabeth M
Neuronal activity in single prefrontal neurons has been correlated with behavioral responses, rules, task variables and stimulus features. In the non-human primate, neurons recorded in ventrolateral prefrontal cortex (VLPFC) have been found to respond to species-specific vocalizations. Previous studies have found multisensory neurons which respond to simultaneously presented faces and vocalizations in this region. Behavioral data suggests that face and vocal information are inextricably linked in animals and humans and therefore may also be tightly linked in the coding of communication calls in prefrontal neurons. In this study we therefore examined the role of VLPFC in encoding vocalization call type information. Specifically, we examined previously recorded single unit responses from the VLPFC in awake, behaving rhesus macaques in response to 3 types of species-specific vocalizations made by 3 individual callers. Analysis of responses by vocalization call type and caller identity showed that ∼19% of cells had a main effect of call type with fewer cells encoding caller. Classification performance of VLPFC neurons was ∼42% averaged across the population. When assessed at discrete time bins, classification performance reached 70 percent for coos in the first 300 ms and remained above chance for the duration of the response period, though performance was lower for other call types. In light of the sub-optimal classification performance of the majority of VLPFC neurons when only vocal information is present, and the recent evidence that most VLPFC neurons are multisensory, the potential enhancement of classification with the addition of accompanying face information is discussed and additional studies recommended. Behavioral and neuronal evidence has shown a considerable benefit in recognition and memory performance when faces and voices are presented simultaneously. In the natural environment both facial and vocalization information is present simultaneously and
Liu Yan; Xia Hong
As one of the main type of reactors in the future, the development of the integral reactor has attracted worldwide attention. On the basis of understanding the background of the integral reactor, the author will be familiar with and master the power control of reactor and the feedwater flow control of steam generator, and the speed control of turbine (turbine speed control is associated with the turbine load control). According to the expectative program 'reactor power following turbine load' of the reactor, it will make coordinate control of the three and come to a overall control scheme. The author will use the supervisory learning algorithm of Hebb for single neuron PID controller with self-adaptation to study the coordinate control of integral reactor. Compared with conventional PI or PID controller, to a certain extent, it solves the problems that traditional PID controller is not easy to tune real-time parameters and lack of effective control for a number of complex processes and slow-varying parameter systems. It improves the security, reliability, stability and flexibility of control process and achieves effective control of the system. (authors)
Mouterde, Solveig C; Elie, Julie E; Mathevon, Nicolas; Theunissen, Frédéric E
One of the most complex tasks performed by sensory systems is "scene analysis": the interpretation of complex signals as behaviorally relevant objects. The study of this problem, universal to species and sensory modalities, is particularly challenging in audition, where sounds from various sources and localizations, degraded by propagation through the environment, sum to form a single acoustical signal. Here we investigated in a songbird model, the zebra finch, the neural substrate for ranging and identifying a single source. We relied on ecologically and behaviorally relevant stimuli, contact calls, to investigate the neural discrimination of individual vocal signature as well as sound source distance when calls have been degraded through propagation in a natural environment. Performing electrophysiological recordings in anesthetized birds, we found neurons in the auditory forebrain that discriminate individual vocal signatures despite long-range degradation, as well as neurons discriminating propagation distance, with varying degrees of multiplexing between both information types. Moreover, the neural discrimination performance of individual identity was not affected by propagation-induced degradation beyond what was induced by the decreased intensity. For the first time, neurons with distance-invariant identity discrimination properties as well as distance-discriminant neurons are revealed in the avian auditory cortex. Because these neurons were recorded in animals that had prior experience neither with the vocalizers of the stimuli nor with long-range propagation of calls, we suggest that this neural population is part of a general-purpose system for vocalizer discrimination and ranging. SIGNIFICANCE STATEMENT Understanding how the brain makes sense of the multitude of stimuli that it continually receives in natural conditions is a challenge for scientists. Here we provide a new understanding of how the auditory system extracts behaviorally relevant information
Doron, Guy; von Heimendahl, Moritz; Schlattmann, Peter; Houweling, Arthur R; Brecht, Michael
The action potential activity of single cortical neurons can evoke measurable sensory effects, but it is not known how spiking parameters and neuronal subtypes affect the evoked sensations. Here, we examined the effects of spike train irregularity, spike frequency, and spike number on the detectability of single-neuron stimulation in rat somatosensory cortex. For regular-spiking, putative excitatory neurons, detectability increased with spike train irregularity and decreasing spike frequencies but was not affected by spike number. Stimulation of single, fast-spiking, putative inhibitory neurons led to a larger sensory effect compared to regular-spiking neurons, and the effect size depended only on spike irregularity. An ideal-observer analysis suggests that, under our experimental conditions, rats were using integration windows of a few hundred milliseconds or more. Our data imply that the behaving animal is sensitive to single neurons' spikes and even to their temporal patterning. Copyright © 2014 Elsevier Inc. All rights reserved.
Kebschull, Justus M; Garcia da Silva, Pedro; Reid, Ashlan P; Peikon, Ian D; Albeanu, Dinu F; Zador, Anthony M
Neurons transmit information to distant brain regions via long-range axonal projections. In the mouse, area-to-area connections have only been systematically mapped using bulk labeling techniques, which obscure the diverse projections of intermingled single neurons. Here we describe MAPseq (Multiplexed Analysis of Projections by Sequencing), a technique that can map the projections of thousands or even millions of single neurons by labeling large sets of neurons with random RNA sequences ("barcodes"). Axons are filled with barcode mRNA, each putative projection area is dissected, and the barcode mRNA is extracted and sequenced. Applying MAPseq to the locus coeruleus (LC), we find that individual LC neurons have preferred cortical targets. By recasting neuroanatomy, which is traditionally viewed as a problem of microscopy, as a problem of sequencing, MAPseq harnesses advances in sequencing technology to permit high-throughput interrogation of brain circuits. Copyright © 2016 Elsevier Inc. All rights reserved.
Li Chunguang; Chen Guanrong
In this paper, we consider the nonlinear dynamical behavior of a single neuron model with adapting feedback synapse, and show that chaotic behaviors exist in this model. In some parameter domain, we observe two coexisting chaotic attractors, switching from the coexisting chaotic attractors to a connected chaotic attractor, and then switching back to the two coexisting chaotic attractors. We confirm the chaoticity by simulations with phase plots, waveform plots, and power spectra
Valcu, Bogdan F.
This dissertation uses both micromagnetic simulation and analytical methods to analyze several aspects of a perpendicular recording system. To increase the head field amplitude, the recording layer is grown on top of a soft magnetic layer (keeper). There is concern about the ability of the keeper to conduct the magnetic flux from the head at high data rates. We compute numerically the magnetization motion of the soft underlayer during the reversal process. Generation of non-linear spin waves characterizes the magnetization dynamics in the keeper, the spins are oscillating with a frequency higher than that of the reversal current. However, the recording field applied to the data layer follows the time dependence of the input wave form. The written transition shape is determined by the competition between the head field gradient and the demagnetizing field gradient. An analytical slope model that takes into consideration the angular orientation of the applied field is used to estimate the transition parameter; agreement is shown with the micromagnetic results. On the playback side, the reciprocity principle is applied to calculate the read out signal from a single magnetic transition in the perpendicular medium. The pulse shape is close to an error-function, going through zero when the sensor is above the transition center and decaying from the peak to an asymptotic value when the transition center is far away. Analytical closed forms for both the slope in the origin and the asymptotic value show the dependence on the recording geometry parameters. The Signal-to-Noise Ratio is calculated assuming that the noise is dominated by the medium jitter. To keep the SNR at a readable level while increasing the areal density, the average magnetic grain diameter must decrease; consequently grain size fluctuations will affect the thermal decay. We performed Transmission Electron Microscopy measurements and observed differences in the grain size distribution between various types
Schneider, David M; Woolley, Sarah M N
Many social animals including songbirds use communication vocalizations for individual recognition. The perception of vocalizations depends on the encoding of complex sounds by neurons in the ascending auditory system, each of which is tuned to a particular subset of acoustic features. Here, we examined how well the responses of single auditory neurons could be used to discriminate among bird songs and we compared discriminability to spectrotemporal tuning. We then used biologically realistic models of pooled neural responses to test whether the responses of groups of neurons discriminated among songs better than the responses of single neurons and whether discrimination by groups of neurons was related to spectrotemporal tuning and trial-to-trial response variability. The responses of single auditory midbrain neurons could be used to discriminate among vocalizations with a wide range of abilities, ranging from chance to 100%. The ability to discriminate among songs using single neuron responses was not correlated with spectrotemporal tuning. Pooling the responses of pairs of neurons generally led to better discrimination than the average of the two inputs and the most discriminating input. Pooling the responses of three to five single neurons continued to improve neural discrimination. The increase in discriminability was largest for groups of neurons with similar spectrotemporal tuning. Further, we found that groups of neurons with correlated spike trains achieved the largest gains in discriminability. We simulated neurons with varying levels of temporal precision and measured the discriminability of responses from single simulated neurons and groups of simulated neurons. Simulated neurons with biologically observed levels of temporal precision benefited more from pooling correlated inputs than did neurons with highly precise or imprecise spike trains. These findings suggest that pooling correlated neural responses with the levels of precision observed in the
Feng, Peihua; Wu, Ying; Zhang, Jiazhong
Non-linear behaviors of a single neuron described by Fitzhugh-Nagumo (FHN) neuron model, with external electromagnetic radiation considered, is investigated. It is discovered that with external electromagnetic radiation in form of a cosine function, the mode selection of membrane potential occurs among periodic, quasi-periodic, and chaotic motions as increasing the frequency of external transmembrane current, which is selected as a sinusoidal function. When the frequency is small or large enough, periodic, and quasi-periodic motions are captured alternatively. Otherwise, when frequency is in interval 0.778 electromagnetic radiation. The frequency apparently plays a more important role in determining the system behavior.
Ryan T Canolty
Full Text Available Understanding the principles governing the dynamic coordination of functional brain networks remains an important unmet goal within neuroscience. How do distributed ensembles of neurons transiently coordinate their activity across a variety of spatial and temporal scales? While a complete mechanistic account of this process remains elusive, evidence suggests that neuronal oscillations may play a key role in this process, with different rhythms influencing both local computation and long-range communication. To investigate this question, we recorded multiple single unit and local field potential (LFP activity from microelectrode arrays implanted bilaterally in macaque motor areas. Monkeys performed a delayed center-out reach task either manually using their natural arm (Manual Control, MC or under direct neural control through a brain-machine interface (Brain Control, BC. In accord with prior work, we found that the spiking activity of individual neurons is coupled to multiple aspects of the ongoing motor beta rhythm (10-45 Hz during both MC and BC, with neurons exhibiting a diversity of coupling preferences. However, here we show that for identified single neurons, this beta-to-rate mapping can change in a reversible and task-dependent way. For example, as beta power increases, a given neuron may increase spiking during MC but decrease spiking during BC, or exhibit a reversible shift in the preferred phase of firing. The within-task stability of coupling, combined with the reversible cross-task changes in coupling, suggest that task-dependent changes in the beta-to-rate mapping play a role in the transient functional reorganization of neural ensembles. We characterize the range of task-dependent changes in the mapping from beta amplitude, phase, and inter-hemispheric phase differences to the spike rates of an ensemble of simultaneously-recorded neurons, and discuss the potential implications that dynamic remapping from oscillatory activity to
Burton, H; Sinclair, R J
Clinical and neuroimaging observations of the cortical network implicated in tactile attention have identified foci in parietal somatosensory, posterior parietal, and superior frontal locations. Tasks involving intentional hand-arm movements activate similar or nearby parietal and frontal foci. Visual spatial attention tasks and deliberate visuomotor behavior also activate overlapping posterior parietal and frontal foci. Studies in the visual and somatosensory systems thus support a proposal that attention to the spatial location of an object engages cortical regions responsible for the same coordinate referents used for guiding purposeful motor behavior. Tactile attention also biases processing in the somatosensory cortex through amplification of responses to relevant features of selected stimuli. Psychophysical studies demonstrate retention gradients for tactile stimuli like those reported for visual and auditory stimuli, and suggest analogous neural mechanisms for working memory across modalities. Neuroimaging studies in humans using memory tasks, and anatomic studies in monkeys support the idea that tactile information relayed from the somatosensory cortex is directed ventrally through the insula to the frontal cortex for short-term retention and to structures of the medial temporal lobe for long-term encoding. At the level of single neurons, tactile (such as visual and auditory) short-term memory appears as a persistent response during delay intervals between sampled stimuli.
Lotfi, Ehsan; Akbarzadeh-T, M-R
We propose a biologically motivated brain-inspired single neuron perceptron (SNP) with universal approximation and XOR computation properties. This computational model extends the input pattern and is based on the excitatory and inhibitory learning rules inspired from neural connections in the human brain's nervous system. The resulting architecture of SNP can be trained by supervised excitatory and inhibitory online learning rules. The main features of proposed single layer perceptron are universal approximation property and low computational complexity. The method is tested on 6 UCI (University of California, Irvine) pattern recognition and classification datasets. Various comparisons with multilayer perceptron (MLP) with gradient decent backpropagation (GDBP) learning algorithm indicate the superiority of the approach in terms of higher accuracy, lower time, and spatial complexity, as well as faster training. Hence, we believe the proposed approach can be generally applicable to various problems such as in pattern recognition and classification.
Egger, Robert; Narayanan, Rajeevan T.; Helmstaedter, Moritz; de Kock, Christiaan P. J.; Oberlaender, Marcel
The three-dimensional (3D) structure of neural circuits is commonly studied by reconstructing individual or small groups of neurons in separate preparations. Investigation of structural organization principles or quantification of dendritic and axonal innervation thus requires integration of many reconstructed morphologies into a common reference frame. Here we present a standardized 3D model of the rat vibrissal cortex and introduce an automated registration tool that allows for precise placement of single neuron reconstructions. We (1) developed an automated image processing pipeline to reconstruct 3D anatomical landmarks, i.e., the barrels in Layer 4, the pia and white matter surfaces and the blood vessel pattern from high-resolution images, (2) quantified these landmarks in 12 different rats, (3) generated an average 3D model of the vibrissal cortex and (4) used rigid transformations and stepwise linear scaling to register 94 neuron morphologies, reconstructed from in vivo stainings, to the standardized cortex model. We find that anatomical landmarks vary substantially across the vibrissal cortex within an individual rat. In contrast, the 3D layout of the entire vibrissal cortex remains remarkably preserved across animals. This allows for precise registration of individual neuron reconstructions with approximately 30 µm accuracy. Our approach could be used to reconstruct and standardize other anatomically defined brain areas and may ultimately lead to a precise digital reference atlas of the rat brain. PMID:23284282
For the past 10 or more years, Analytical Laboratory data cards have been generated and stored in the 222-S Laboratory at the Hanford Site in Richland, Washington. These cards are classified as record material and require retention for a minimum of 75 years in an approved storage facility in accordance with Westinghouse Hanford Company procedures. The cards are maintained in records boxes in the attic of the 222-S Laboratory and are subject to potential risk and loss. The most significant potential risks are radiological hazards. Various options are available for removal, cataloging, transmittal, and storage of these long-term records. Because the records are currently stored in a radiation protection zone, they surveyed before being released from the facility. This survey can be arduous and time consuming. Resolutions to the problem of removal and proper storage of the records from the facility need to be addressed. The records were reviewed and inventoried to determine the quantity of information. A study of the various options available was conducted, and based on the information collected, it was determined that the most feasible and cost-effective approach is to microfilm the cards inside the laboratory. This option complies with all applicable company requirements and decreases the estimated radiological survey time from approximately 3.5 years to under 40 hours. This activity will result in a potential savings of $350,000 over the life of the activity
Full Text Available Experiment has demonstrated that summation of excitatory post-synaptic protientials (EPSPs in dendrites is non-linear. The sum of multiple EPSPs can be larger than their arithmetic sum, a superlinear summation due to the opening of voltage-gated channels and similar to somatic spiking. The so-called dendritic spike. The sum of multiple of EPSPs can also be smaller than their arithmetic sum, because the synaptic current necessarily saturates at some point. While these observations are well-explained by biophysical models the impact of dendritic spikes on computation remains a matter of debate. One reason is that dendritic spikes may fail to make the neuron spike; similarly, dendritic saturations are sometime presented as a glitch which should be corrected by dendritic spikes. We will provide solid arguments against this claim and show that dendritic saturations as well as dendritic spikes enhance single neuron computation, even when they cannot directly make the neuron fire. To explore the computational impact of dendritic spikes and saturations, we are using a binary neuron model in conjunction with Boolean algebra. We demonstrate using these tools that a single dendritic non-linearity, either spiking or saturating, combined with somatic non-linearity, enables a neuron to compute linearly non-separable Boolean functions (lnBfs. These functions are impossible to compute when summation is linear and the exclusive OR is a famous example of lnBfs. Importantly, the implementation of these functions does not require the dendritic non-linearity to make the neuron spike. Next, We show that reduced and realistic biophysical models of the neuron are capable of computing lnBfs. Within these models and contrary to the binary model, the dendritic and somatic non-linearity are tightly coupled. Yet we show that these neuron models are capable of linearly non-separable computations.
Munro, Paul Wesley
A special form for modification of neuronal response properties is described in which the change in the synaptic state vector is parallel to the vector of afferent activity. This process is termed "parallel modification" and its theoretical and experimental implications are examined. A theoretical framework has been devised to describe the complementary functions of generalization and discrimination by single neurons. This constitutes a basis for three models each describing processes for the development of maximum selectivity (discrimination) and minimum selectivity (generalization) by neurons. Strengthening and weakening of synapses is expressed as a product of the presynaptic activity and a nonlinear modulatory function of two postsynaptic variables--namely a measure of the spatially integrated activity of the cell and a temporal integration (time-average) of that activity. Some theorems are given for low-dimensional systems and computer simulation results from more complex systems are discussed. Model neurons that achieve high selectivity mimic the development of cat visual cortex neurons in a wide variety of rearing conditions. A role for low-selectivity neurons is proposed in which they provide inhibitory input to neurons of the opposite type, thereby suppressing the common component of a pattern class and enhancing their selective properties. Such contrast-enhancing circuits are analyzed and supported by computer simulation. To enable maximum selectivity, the net inhibition to a cell must become strong enough to offset whatever excitation is produced by the non-preferred patterns. Ramifications of parallel models for certain experimental paradigms are analyzed. A methodology is outlined for testing synaptic modification hypotheses in the laboratory. A plastic projection from one neuronal population to another will attain stable equilibrium under periodic electrical stimulation of constant intensity. The perturbative effect of shifting this intensity level
Full Text Available In a companion paper (Nere et al., this volume, we used computer simulations to show that a strategy of activity-dependent, on-line net synaptic potentiation during wake, followed by off-line synaptic depression during sleep, can provide a parsimonious account for several memory benefits of sleep at the systems level, including the consolidation of procedural and declarative memories, gist extraction, and integration of new with old memories. In this paper, we consider the theoretical benefits of this two-step process at the single neuron level and employ the theoretical notion of Matching between brain and environment to measure how this process increases the ability of the neuron to capture regularities in the environment and model them internally. We show that down-selection during sleep is beneficial for increasing or restoring Matching after learning, after integrating new with old memories, and after forgetting irrelevant material. By contrast, alternative schemes, such as additional potentiation in wake, potentiation in sleep, or synaptic renormalization in wake, decrease Matching. We also argue that, by selecting appropriate loops through the brain that tie feedforward synapses with feedback ones in the same dendritic domain, different subsets of neurons can learn to specialize for different contingencies and form sequences of nested perception-action loops. By potentiating such loops when interacting with the environment in wake, and depressing them when disconnected from the environment in sleep, neurons can learn to match the long-term statistical structure of the environment while avoiding spurious modes of functioning and catastrophic interference. Finally, such a two-step process has the additional benefit of desaturating the neuron's ability to learn and of maintaining cellular homeostasis. Thus, sleep-dependent synaptic renormalization offers a parsimonious account for both cellular and systems-level effects of sleep on learning
Full Text Available In this paper, a novel data-driven single neuron predictive control strategy is proposed for non-Gaussian networked control systems with metrology delays in the information theory framework. Firstly, survival information potential (SIP, instead of minimum entropy, is used to formulate the performance index to characterize the randomness of the considered systems, which is calculated by oversampling method. Then the minimum values can be computed by optimizing the SIP-based performance index. Finally, the proposed strategy, minimum entropy method and mean square error (MSE are applied to a networked motor control system, and results demonstrated the effectiveness of the proposed strategy.
Wang, Zhen; Wang, Xiaohong; Li, Yuxia; Huang, Xia
In this paper, the problems of stability and Hopf bifurcation in a class of fractional-order complex-valued single neuron model with time delay are addressed. With the help of the stability theory of fractional-order differential equations and Laplace transforms, several new sufficient conditions, which ensure the stability of the system are derived. Taking the time delay as the bifurcation parameter, Hopf bifurcation is investigated and the critical value of the time delay for the occurrence of Hopf bifurcation is determined. Finally, two representative numerical examples are given to show the effectiveness of the theoretical results.
Carlson, Bruce A
Sensory systems often encode stimulus information into the temporal pattern of action potential activity. However, little is known about how the information contained within these patterns is extracted by postsynaptic neurons. Similar to temporal coding by sensory neurons, social information in mormyrid fish is encoded into the temporal patterning of an electric organ discharge. In the current study, sensitivity to temporal patterns of electrosensory stimuli was found to arise within the midbrain posterior exterolateral nucleus (ELp). Whole-cell patch recordings from ELp neurons in vivo revealed three patterns of interpulse interval (IPI) tuning: low-pass neurons tuned to long intervals, high-pass neurons tuned to short intervals, and bandpass neurons tuned to intermediate intervals. Many neurons within each class also responded preferentially to either increasing or decreasing IPIs. Playback of electric signaling patterns recorded from freely behaving fish revealed that the IPI and direction tuning of ELp neurons resulted in selective responses to particular social communication displays characterized by distinct IPI patterns. The postsynaptic potential responses of many neurons indicated a combination of excitatory and inhibitory synaptic input, and the IPI tuning of ELp neurons was directly related to rate-dependent changes in the direction and amplitude of postsynaptic potentials. These results suggest that differences in the dynamics of short-term synaptic plasticity in excitatory and inhibitory pathways may tune central sensory neurons to particular temporal patterns of presynaptic activity. This may represent a general mechanism for the processing of behaviorally relevant stimulus information encoded into temporal patterns of activity by sensory neurons.
He, Na; Kong, Lingzhi; Lin, Tao; Wang, Shaohui; Liu, Xiuping; Qi, Jiyao; Yan, Jun
Binaural hearing confers many beneficial functions but our understanding of its underlying neural substrates is limited. This study examines the bilateral synaptic assemblies and binaural computation (or integration) in the central nucleus of the inferior colliculus (ICc) of the auditory midbrain, a key convergent center. Using in-vivo whole-cell patch-clamp, the excitatory and inhibitory postsynaptic potentials (EPSPs/IPSPs) of single ICc neurons to contralateral, ipsilateral and bilateral stimulation were recorded. According to the contralateral and ipsilateral EPSP/IPSP, 7 types of bilateral synaptic assemblies were identified. These include EPSP-EPSP (EE), E-IPSP (EI), E-no response (EO), II, IE, IO and complex-mode (CM) neurons. The CM neurons showed frequency- and/or amplitude-dependent EPSPs/IPSPs to contralateral or ipsilateral stimulation. Bilateral stimulation induced EPSPs/IPSPs that could be larger than (facilitation), similar to (ineffectiveness) or smaller than (suppression) those induced by contralateral stimulation. Our findings have allowed our group to characterize novel neural circuitry for binaural computation in the midbrain. Copyright © 2017 Elsevier B.V. All rights reserved.
Kottas, Athanasios; Behseta, Sam
We propose a fully inferential model-based approach to the problem of comparing the firing patterns of a neuron recorded under two distinct experimental conditions. The methodology is based on nonhomogeneous Poisson process models for the firing times of each condition with flexible nonparametric mixture prior models for the corresponding intensity functions. We demonstrate posterior inferences from a global analysis, which may be used to compare the two conditions over the entire experimental time window, as well as from a pointwise analysis at selected time points to detect local deviations of firing patterns from one condition to another. We apply our method on two neurons recorded from the primary motor cortex area of a monkey's brain while performing a sequence of reaching tasks.
Kreiman, Gabriel; Fried, Itzhak; Koch, Christof
Visual information from the environment is transformed into perceptual sensations through several stages of neuronal processing. Flash suppression constitutes a striking example in which the same retinal input can give rise to two different conscious visual percepts. We directly recorded the responses of individual neurons during flash suppression in the human amygdala, entorhinal cortex, hippocampus, and parahippocampal gyrus, allowing us to explore the neuronal responses in untrained subjec...
Fried, Itzhak; Mukamel, Roy; Kreiman, Gabriel
Understanding how self-initiated behavior is encoded by neuronal circuits in the human brain remains elusive. We recorded the activity of 1019 neurons while twelve subjects performed self-initiated finger movement. We report progressive neuronal recruitment over ∼1500 ms before subjects report making the decision to move. We observed progressive increase or decrease in neuronal firing rate, particularly in the supplementary motor area (SMA), as the reported time of decision was approached. A ...
Fried, Itzhak; Mukamel, Roy; Kreiman, Gabriel
Understanding how self-initiated behavior is encoded by neuronal circuits in the human brain remains elusive. We recorded the activity of 1019 neurons while twelve subjects performed self-initiated finger movement. We report progressive neuronal recruitment over ~1500 ms before subjects report making the decision to move. We observed progressive increase or decrease in neuronal firing rate, particularly in the supplementary motor area (SMA), as the reported time of decision was approached. A population of 256 SMA neurons is sufficient to predict in single trials the impending decision to move with accuracy greater than 80% already 700 ms prior to subjects’ awareness. Furthermore, we predict, with a precision of a few hundred ms, the actual time point of this voluntary decision to move. We implement a computational model whereby volition emerges once a change in internally generated firing rate of neuronal assemblies crosses a threshold. PMID:21315264
Rodríguez, Ana R.; O'Neill, Kate M.; Swiatkowski, Przemyslaw; Patel, Mihir V.; Firestein, Bonnie L.
Objective. This study investigates the effect that overexpression of cytosolic PSD-95 interactor (cypin), a regulator of synaptic PSD-95 protein localization and a core regulator of dendrite branching, exerts on the electrical activity of rat hippocampal neurons and networks. Approach. We cultured rat hippocampal neurons and used lipid-mediated transfection and lentiviral gene transfer to achieve high levels of cypin or cypin mutant (cypinΔPDZ PSD-95 non-binding) expression cellularly and network-wide, respectively. Main results. Our analysis revealed that although overexpression of cypin and cypinΔPDZ increase dendrite numbers and decrease spine density, cypin and cypinΔPDZ distinctly regulate neuronal activity. At the single cell level, cypin promotes decreases in bursting activity while cypinΔPDZ reduces sEPSC frequency and further decreases bursting compared to cypin. At the network level, by using the Fano factor as a measure of spike count variability, cypin overexpression results in an increase in variability of spike count, and this effect is abolished when cypin cannot bind PSD-95. This variability is also dependent on baseline activity levels and on mean spike rate over time. Finally, our spike sorting data show that overexpression of cypin results in a more complex distribution of spike waveforms and that binding to PSD-95 is essential for this complexity. Significance. Our data suggest that dendrite morphology does not play a major role in cypin action on electrical activity.
Uzuntarla, M.; Ozer, M.; Ileri, U.; Calim, A.; Torres, J. J.
The noise-delayed decay (NDD) phenomenon emerges when the first-spike latency of a periodically forced stochastic neuron exhibits a maximum for a particular range of noise intensity. Here, we investigate the latency response dynamics of a single Hodgkin-Huxley neuron that is subject to both a suprathreshold periodic stimulus and a background activity arriving through dynamic synapses. We study the first-spike latency response as a function of the presynaptic firing rate f . This constitutes a more realistic scenario than previous works, since f provides a suitable biophysically realistic parameter to control the level of activity in actual neural systems. We first report on the emergence of classical NDD behavior as a function of f for the limit of static synapses. Second, we show that when short-term depression and facilitation mechanisms are included at the synapses, different NDD features can be found due to their modulatory effect on synaptic current fluctuations. For example, an intriguing double NDD (DNDD) behavior occurs for different sets of relevant synaptic parameters. Moreover, depending on the balance between synaptic depression and synaptic facilitation, single NDD or DNDD can prevail, in such a way that synaptic facilitation favors the emergence of DNDD whereas synaptic depression favors the existence of single NDD. Here we report the existence of the DNDD effect in the response latency dynamics of a neuron.
Dimitrios V Vavoulis
Full Text Available Traditional approaches to the problem of parameter estimation in biophysical models of neurons and neural networks usually adopt a global search algorithm (for example, an evolutionary algorithm, often in combination with a local search method (such as gradient descent in order to minimize the value of a cost function, which measures the discrepancy between various features of the available experimental data and model output. In this study, we approach the problem of parameter estimation in conductance-based models of single neurons from a different perspective. By adopting a hidden-dynamical-systems formalism, we expressed parameter estimation as an inference problem in these systems, which can then be tackled using a range of well-established statistical inference methods. The particular method we used was Kitagawa's self-organizing state-space model, which was applied on a number of Hodgkin-Huxley-type models using simulated or actual electrophysiological data. We showed that the algorithm can be used to estimate a large number of parameters, including maximal conductances, reversal potentials, kinetics of ionic currents, measurement and intrinsic noise, based on low-dimensional experimental data and sufficiently informative priors in the form of pre-defined constraints imposed on model parameters. The algorithm remained operational even when very noisy experimental data were used. Importantly, by combining the self-organizing state-space model with an adaptive sampling algorithm akin to the Covariance Matrix Adaptation Evolution Strategy, we achieved a significant reduction in the variance of parameter estimates. The algorithm did not require the explicit formulation of a cost function and it was straightforward to apply on compartmental models and multiple data sets. Overall, the proposed methodology is particularly suitable for resolving high-dimensional inference problems based on noisy electrophysiological data and, therefore, a
Pedro Luiz Cortês
Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.
Full Text Available Musicians generally believe that memory differs from one person to the next. As a result, memorizing strategies that could be useful to almost everyone are not widely taught. We describe how an 18-year old piano student (Grade 7, ABRSM, learned to memorize by recording her thoughts, a technique inspired by studies of how experienced soloists memorize. The student, who had previously ignored suggestions that she play from memory, decided to learn to memorize, selecting Schumann’s Der Dichter Spricht for this purpose. Rather than explicitly teaching the student how to memorize, the teacher taught her to record her thoughts while playing by marking them on copies of the score, adapting an approach used previously in research with experienced performers. Over a 6½ week period, the student recorded her thoughts during practice (5 times and while performing from memory for the teacher (3 times. The student also video-recorded three weeks of practice, three performances, and the reconstruction of the piece from memory after a 9½-weeks break. The thoughts that the student reported were prepared during practice, stable over time, and functioned as memory retrieval cues during reconstruction. This suggests that the student memorized in the same way as the more experienced musicians who have been studied previously and that teaching student musicians to record their thoughts may be an effective way to help them memorize. The speed and durability of her memorization surprised the student, inspiring her to perform in public and to use the same technique for new pieces.
Lisboa, Tania; Chaffin, Roger; Demos, Alexander P.
Musicians generally believe that memory differs from one person to the next. As a result, memorizing strategies that could be useful to almost everyone are not widely taught. We describe how an 18-years old piano student (Grade 7, ABRSM), learned to memorize by recording her thoughts, a technique inspired by studies of how experienced soloists memorize. The student, who had previously ignored suggestions that she play from memory, decided to learn to memorize, selecting Schumann’s “Der Dichter Spricht” for this purpose. Rather than explicitly teaching the student how to memorize, the teacher taught her to record her thoughts while playing by marking them on copies of the score, adapting an approach used previously in research with experienced performers. Over a 6½ week period, the student recorded her thoughts during practice (five times) and while performing from memory for the teacher (three times). The student also video-recorded 3 weeks of practice, three performances, and the reconstruction of the piece from memory after a 9½-weeks break. The thoughts that the student reported were prepared during practice, stable over time, and functioned as memory retrieval cues during reconstruction. This suggests that the student memorized in the same way as the more experienced musicians who have been studied previously and that teaching student musicians to record their thoughts may be an effective way to help them memorize. The speed and durability of her memorization surprised the student, inspiring her to perform in public and to use the same technique for new pieces. PMID:25667574
Alaska's summer of 2005 was the second warmest on record there, with a record retreat of arctic pack ice. As Alaskan temperatures gradually increase, artic birds, such as the black guillemots of Cooper Island, near Barrow, Alaska, are experiencing drastic habitat changes. Though these small black and white birds—the subjects of a long-term study of climate change—fared better this year than they have in the recent past (due to local cool conditions), they are nonetheless struggling to adapt as their artic island summer home becomes subarctic.George Divokyan ornithologist at the Institute of Arctic Biology, University of Alaska Fairbanks, discovered the Cooper Island colony of guillemots in the early 1970s and has spent every summer since 1975 there studying these birds. He presented his latest research during a 3 November talk in Washington, D.C.
Kent, Alexander R.; Grill, Warren M.
Objective. Closed-loop deep brain stimulation (DBS) systems have the potential to optimize treatment of movement disorders by enabling automatic adjustment of stimulation parameters based on a feedback signal. Evoked compound action potentials (ECAPs) and local field potentials (LFPs) recorded from the DBS electrode may serve as suitable closed-loop control signals. The objective of this study was to understand better the factors that influence ECAP and LFP recording, including the physical presence of the electrode, the geometrical dimensions of the electrode, and changes in the composition of the peri-electrode space across recording conditions. Approach. Coupled volume conductor-neuron models were used to calculate single-unit activity as well as ECAP responses and LFP activity from a population of model thalamic neurons. Main results. Comparing ECAPs and LFPs measured with and without the presence of the highly conductive recording contacts, we found that the presence of these contacts had a negligible effect on the magnitude of single-unit recordings, ECAPs (7% RMS difference between waveforms), and LFPs (5% change in signal magnitude). Spatial averaging across the contact surface decreased the ECAP magnitude in a phase-dependent manner (74% RMS difference), resulting from a differential effect of the contact on the contribution from nearby or distant elements, and decreased the LFP magnitude (25% change). Reductions in the electrode diameter or recording contact length increased signal energy and increased spatial sensitivity of single neuron recordings. Moreover, smaller diameter electrodes (500 µm) were more selective for recording from local cells over passing axons, with the opposite true for larger diameters (1500 µm). Changes in electrode dimensions had phase-dependent effects on ECAP characteristics, and generally had small effects on the LFP magnitude. ECAP signal energy and LFP magnitude decreased with tighter contact spacing (100 µm), compared to
Bagley, Pam; Hudson, Mary; Green, John; Forster, Anne; Young, John
To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. Comparison of physiotherapy staff's recording of treatment sessions and video recording. Rehabilitation stroke unit in a general hospital. Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.
Jan 9, 2013 ... 2Applied Spectroscopy Division, Bhabha Atomic Research Centre, Mumbai 400 085, India. ∗ ... It can be applied not only to crystals, but ... is used and the transmitted beam intensity from the sample is recorded on a position-.
Beierle, Thomas C.; Cayford, Jerry [Resources for the Future, Washington, DC (United States)
Public participation has received increasing attention in environmental policy making world wide. Yet research has been inadequate to answer fundamental questions about how successful past programs have been, what factors lead to success, and where efforts to improve public involvement should focus. To address these questions, we examine the case study record of public participation efforts in the United States over the last 30 years. We evaluate the success of numerous examples of public participation in environmental decision making and identify the factors that lead to success. The paper deals with a number of themes, including: The extent to which participation can incorporate public values into decision making, improve the substantive quality of decisions, reduce conflict, increase trust in institutions, and educate and inform the public; What can be expected from different approaches to public participation, such as public meetings, advisory committees, and mediation; The relative importance of the participatory process vs. the context in which participation takes place; Procedural features of particular importance; and The relationship between participation and implementation. The paper provides general results that can be used to guide the improvement of public participation programs, support assessment of innovative methods, and advance the theoretical understanding of public participation.
Beierle, Thomas C.; Cayford, Jerry
Public participation has received increasing attention in environmental policy making world wide. Yet research has been inadequate to answer fundamental questions about how successful past programs have been, what factors lead to success, and where efforts to improve public involvement should focus. To address these questions, we examine the case study record of public participation efforts in the United States over the last 30 years. We evaluate the success of numerous examples of public participation in environmental decision making and identify the factors that lead to success. The paper deals with a number of themes, including: The extent to which participation can incorporate public values into decision making, improve the substantive quality of decisions, reduce conflict, increase trust in institutions, and educate and inform the public; What can be expected from different approaches to public participation, such as public meetings, advisory committees, and mediation; The relative importance of the participatory process vs. the context in which participation takes place; Procedural features of particular importance; and The relationship between participation and implementation. The paper provides general results that can be used to guide the improvement of public participation programs, support assessment of innovative methods, and advance the theoretical understanding of public participation
van Unen, Robert J; Tichelaar, Jelle; Nanayakkara, Prabath W B; van Agtmael, Michiel A; Richir, Milan C; de Vries, Theo P G M
Several studies have demonstrated that using a template for recording general and diagnostic information in the medical record (MR) improves the completeness of MR documentation, communication between doctors, and performance of doctors. However, little is known about how therapeutic information should be structured in the MR. The aim of this study was to investigate which specific therapeutic information registrars and consultants in internal medicine consider essential to record in the MR. Therefore, we carried out a 2-round Internet Delphi study. Fifty-nine items were assessed on a 5-point scale; an item was considered important if ≥ 80% of the respondents awarded it a score of 4 or 5. In total, 26 registrars and 30 consultants in internal medicine completed both rounds of the study. Overall, they considered it essential to include information about 11 items in the MR. Subgroup analyses revealed that the registrars considered 8 additional items essential, whereas the consultants considered 1 additional item essential to record. Study findings can be used as a starting point to develop a structured section of the MR for therapeutic information for both paper and electronic MRs. This section should contain at least 11 items considered essential by registrars and clinical consultants in internal medicine. © 2015, The American College of Clinical Pharmacology.
Photos-Jones, Effie; Hall, Allan J
The method used by archaeologists for excavation and recording of the stratigraphic evidence, within trenches with or without archaeological remains, can potentially be useful to contaminated land consultants (CLCs). The implementation of archaeological practice in contaminated land assessments (CLAs) is not meant to be an exercise in data overkill; neither should it increase costs. Rather, we suggest, that if the excavation and recording, by a trained archaeologist, of the stratigraphy is followed by in-situ chemical characterisation then it is possible that much uncertainty associated with current field sampling practices, may be removed. This is because built into the chemical stratigraphy is the temporal and spatial relationship between different parts of the site reflecting the logic behind the distribution of contamination. An archaeological recording with chemical stratigraphy approach to sampling may possibly provide 'one method fits all' for potentially contaminated land sites (CLSs), just as archaeological characterisation of the stratigraphic record provides 'one method fits all' for all archaeological sites irrespective of period (prehistoric to modern) or type (rural, urban or industrial). We also suggest that there may be practical and financial benefits to be gained by pulling together expertise and resources stemming from different disciplines, not simply at the assessment phase, but also subsequent phases, in contaminated land improvement. Copyright © 2011 Elsevier B.V. All rights reserved.
Llamas-Nistal, Martín; Mikic-Fonte, Fernando A.
The University of Vigo, Vigo, Spain, has the objective of making all the teaching material generated by its teachers freely available. To attain this objective, it encourages the development of Open Educational Resources, especially videos. This paper presents an experience of recording lectures and generating the corresponding videos as a step…
Boone, Deborah R; Sell, Stacy L; Hellmich, Helen Lee
Long-term cognitive disability after TBI is associated with injury-induced neurodegeneration in the hippocampus-a region in the medial temporal lobe that is critical for learning, memory and executive function. Hence our studies focus on gene expression analysis of specific neuronal populations in distinct subregions of the hippocampus. The technique of laser capture microdissection (LCM), introduced in 1996 by Emmert-Buck, et al., has allowed for significant advances in gene expression analysis of single cells and enriched populations of cells from heterogeneous tissues such as the mammalian brain that contains thousands of functional cell types. We use LCM and a well established rat model of traumatic brain injury (TBI) to investigate the molecular mechanisms that underlie the pathogenesis of TBI. Following fluid-percussion TBI, brains are removed at pre-determined times post-injury, immediately frozen on dry ice, and prepared for sectioning in a cryostat. The rat brains can be embedded in OCT and sectioned immediately, or stored several months at -80 °C before sectioning for laser capture microdissection. Additionally, we use LCM to study the effects of TBI on circadian rhythms. For this, we capture neurons from the suprachiasmatic nuclei that contain the master clock of the mammalian brain. Here, we demonstrate the use of LCM to obtain single identified neurons (injured and degenerating, Fluoro-Jade-positive, or uninjured, Fluoro-Jade-negative) and enriched populations of hippocampal neurons for subsequent gene expression analysis by real time PCR and/or whole-genome microarrays. These LCM-enabled studies have revealed that the selective vulnerability of anatomically distinct regions of the rat hippocampus are reflected in the different gene expression profiles of different populations of neurons obtained by LCM from these distinct regions. The results from our single-cell studies, where we compare the transcriptional profiles of dying and adjacent surviving
Sadeh, Sadra; Rotter, Stefan
The neuronal mechanisms underlying the emergence of orientation selectivity in the primary visual cortex of mammals are still elusive. In rodents, visual neurons show highly selective responses to oriented stimuli, but neighboring neurons do not necessarily have similar preferences. Instead of a smooth map, one observes a salt-and-pepper organization of orientation selectivity. Modeling studies have recently confirmed that balanced random networks are indeed capable of amplifying weakly tuned inputs and generating highly selective output responses, even in absence of feature-selective recurrent connectivity. Here we seek to elucidate the neuronal mechanisms underlying this phenomenon by resorting to networks of integrate-and-fire neurons, which are amenable to analytic treatment. Specifically, in networks of perfect integrate-and-fire neurons, we observe that highly selective and contrast invariant output responses emerge, very similar to networks of leaky integrate-and-fire neurons. We then demonstrate that a theory based on mean firing rates and the detailed network topology predicts the output responses, and explains the mechanisms underlying the suppression of the common-mode, amplification of modulation, and contrast invariance. Increasing inhibition dominance in our networks makes the rectifying nonlinearity more prominent, which in turn adds some distortions to the otherwise essentially linear prediction. An extension of the linear theory can account for all the distortions, enabling us to compute the exact shape of every individual tuning curve in our networks. We show that this simple form of nonlinearity adds two important properties to orientation selectivity in the network, namely sharpening of tuning curves and extra suppression of the modulation. The theory can be further extended to account for the nonlinearity of the leaky model by replacing the rectifier by the appropriate smooth input-output transfer function. These results are robust and do not
Full Text Available The neuronal mechanisms underlying the emergence of orientation selectivity in the primary visual cortex of mammals are still elusive. In rodents, visual neurons show highly selective responses to oriented stimuli, but neighboring neurons do not necessarily have similar preferences. Instead of a smooth map, one observes a salt-and-pepper organization of orientation selectivity. Modeling studies have recently confirmed that balanced random networks are indeed capable of amplifying weakly tuned inputs and generating highly selective output responses, even in absence of feature-selective recurrent connectivity. Here we seek to elucidate the neuronal mechanisms underlying this phenomenon by resorting to networks of integrate-and-fire neurons, which are amenable to analytic treatment. Specifically, in networks of perfect integrate-and-fire neurons, we observe that highly selective and contrast invariant output responses emerge, very similar to networks of leaky integrate-and-fire neurons. We then demonstrate that a theory based on mean firing rates and the detailed network topology predicts the output responses, and explains the mechanisms underlying the suppression of the common-mode, amplification of modulation, and contrast invariance. Increasing inhibition dominance in our networks makes the rectifying nonlinearity more prominent, which in turn adds some distortions to the otherwise essentially linear prediction. An extension of the linear theory can account for all the distortions, enabling us to compute the exact shape of every individual tuning curve in our networks. We show that this simple form of nonlinearity adds two important properties to orientation selectivity in the network, namely sharpening of tuning curves and extra suppression of the modulation. The theory can be further extended to account for the nonlinearity of the leaky model by replacing the rectifier by the appropriate smooth input-output transfer function. These results are
Yang, Pengcheng; Li, Yongqin; Chen, Bihua
This Paper presents a portable dynamic ECG monitor system based on MSP430F149 microcontroller. The electrocardiogram detecting system consists of ECG detecting circuit, man-machine interaction module, MSP430F149 and upper computer software. The ECG detecting circuit including a preamplifier, second-order Butterworth low-pass filter, high-pass filter, and 50Hz trap circuit to detects electrocardiogram and depresses various kinds of interference effectively. A microcontroller is used to collect three channel analog signals which can be displayed on TFT LCD. A SD card is used to record real-time data continuously and implement the FTA16 file system. In the end, a host computer system interface is also designed to analyze the ECG signal and the analysis results can provide diagnosis references to clinical doctors.
Full Text Available The overall aim of our research is to develop a monitoring system for neonatal intensive care units. Long-term EEG monitoring in newborns require that the electrodes don’t harm the sensitive skin of the baby, an especially relevant feature for premature babies. Our approach to EEG monitoring is based on several electrodes distributed over the head of the baby, and since the weight of the head always will be on some of them, any type of hard electrode will inevitably cause a pressure-point that can irritate the skin. Therefore, we propose the use of soft conductive textiles as EEG electrodes, primarily for neonates, but also for other kinds of unobtrusive long-term monitoring. In this paper we have tested two types of textile electrodes on five healthy adults and compared them to standard high quality electrodes. The acquired signals were compared with respect to morphology, frequency distribution, spectral coherence, correlation and power line interference sensitivity, and the signals were found to be similar in most respects. The good measurement performance exhibited by the textile electrodes indicates that they are feasible candidates for EEG recording, opening the door for long-term EEG monitoring applications.
Herk-Sukel, Myrthe P P van; Lemmens, Valery E P P; Poll-Franse, Lonneke V van de; Herings, Ron M C; Coebergh, Jan Willem W
An increasing need has developed for the post-approval surveillance of (new) anti-cancer drugs by means of pharmacoepidemiology and outcomes research in the area of oncology. To create an overview that makes researchers aware of the available database linkages in Northern America and Europe which facilitate pharmacoepidemiology and outcomes research in cancer patients. In addition to our own database, i.e. the Eindhoven Cancer Registry (ECR) linked to the PHARMO Record Linkage System, we considered database linkages between a population-based cancer registry and an administrative healthcare database that at least contains information on drug use and offers a longitudinal perspective on healthcare utilization. Eligible database linkages were limited to those that had been used in multiple published articles in English language included in Pubmed. The HMO Cancer Research Network (CRN) in the US was excluded from this review, as an overview of the linked databases participating in the CRN is already provided elsewhere. Researchers who had worked with the data resources included in our review were contacted for additional information and verification of the data presented in the overview. The following database linkages were included: the Surveillance, Epidemiology, and End-Results-Medicare; cancer registry data linked to Medicaid; Canadian cancer registries linked to population-based drug databases; the Scottish cancer registry linked to the Tayside drug dispensing data; linked databases in the Nordic Countries of Europe: Norway, Sweden, Finland and Denmark; and the ECR-PHARMO linkage in the Netherlands. Descriptives of the included database linkages comprise population size, generalizability of the population, year of first data availability, contents of the cancer registry, contents of the administrative healthcare database, the possibility to select a cancer-free control cohort, and linkage to other healthcare databases. The linked databases offer a longitudinal
Bogomolov, C.S.; Razorenova, I.F.; Ruditskaya, I.A.; Khruliova, L.S.
The autoradiography method is widely used in various fields of science and technique and particularly, in medico-biological and medical researches. Combination of autoradiography method and electron microscopy allowed to carry out researches with qualitatively new level and to study radioactive labels, for example, in separate elements of a cell structure. In the present paper there has been carried out a study of nuclear emulsion properties with reference to electron-microscopic autoradiography conditions. (orig./ORU) [de
Lee, K.R.; Cox, G.G.; Templeton, A.W.; Preston, D.F.; Anderson, W.H.; Hensley, K.S.; Dwyer, S.J.
The increase in the use of various imaging modalities demands higher quality and more efficacious analog image recordings. Laser electronic recordings with digital array prints of 4,000 x 5,000 x 12 bits obtained using laser-sensitive film or paper are being evaluated. Dry silver paper recordings are being improved and evaluated. High-resolution paper dot printers are being studied to determine their gray-scale capabilities. The authors evaluated the image quality, costs, clinical utilization, and acceptability of CT scans, MR images, digital subtraction angiograms, digital radiographs, and radionuclide scans recorded by seven different printers (three laser, three silver paper, and one dot) and compared the same features in conventional film recording. This exhibit outlines the technical developments and instrumentation of digital laser film and analog paper recorders and presents the results of the study
Chang Hao Chen
Full Text Available Glass micropipettes are widely used to record neural activity from single neurons or clusters of neurons extracellularly in live animals. However, to date, there has been no comprehensive study of noise in extracellular recordings with glass micropipettes. The purpose of this work was to assess various noise sources that affect extracellular recordings and to create model systems in which novel micropipette neural amplifier designs can be tested. An equivalent circuit of the glass micropipette and the noise model of this circuit, which accurately describe the various noise sources involved in extracellular recordings, have been developed. Measurement schemes using dead brain tissue as well as extracellular recordings from neurons in the inferior colliculus, an auditory brain nucleus of an anesthetized gerbil, were used to characterize noise performance and amplification efficacy of the proposed micropipette neural amplifier. According to our model, the major noise sources which influence the signal to noise ratio are the intrinsic noise of the neural amplifier and the thermal noise from distributed pipette resistance. These two types of noise were calculated and measured and were shown to be the dominating sources of background noise for in vivo experiments.
Davies-Kershaw, Hilary; Petersen, Irene; Nazareth, Irwin; Stevenson, Fiona
Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. A semi-structured qualitative interview study of GPs working in general practices across England. Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. © British Journal of General Practice 2018.
Moatti, L; Busquet, D; Cotin, G
A study was conducted to assess the contribution of cochlear microphonic potential recordings during electrophysiologic audiometry examinations. Amplitude of microphonic recordings were correlated with the degree of deafness, its etiology, and the prosthetic prognosis in 38 electrocochleographic examinations. Preliminary results are analyzed.
Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine
Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current
The primary purpose of this guide is to describe each series of records which pertains to studies of worker health and mortality funded by the U.S. Department of Energy (DOE) at the Hanford site. Additionally, the guide provides information on the location and classification of the records and how they may be accessed. History Associates Incorporated (HAI) prepared this guide as part of its work as the support services contractor for DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of the DOE and the Hanford site, and Hanford`s organizational structure. It provides information on the methodology used to inventory and describe pertinent records stored in various onsite offices, in Hanford`s Records Holding Area (RHA), and at the Seattle Federal Records Center (SFRC). Other topics include the methodology used to produce the guide, the arrangement of the record Series descrimations, and information on accessing records repositories.
Prior, Helen; Bottomley, Anna; Champéroux, Pascal; Cordes, Jason; Delpy, Eric; Dybdal, Noel; Edmunds, Nick; Engwall, Mike; Foley, Mike; Hoffmann, Michael; Kaiser, Robert; Meecham, Ken; Milano, Stéphane; Milne, Aileen; Nelson, Rick; Roche, Brian; Valentin, Jean-Pierre; Ward, Gemma; Chapman, Kathryn
The Safety Pharmacology Society (SPS) and National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs) conducted a survey and workshop in 2015 to define current industry practices relating to housing of non-rodents during telemetry recordings in safety pharmacology and toxicology studies. The aim was to share experiences, canvas opinion on the study procedures/designs that could be used and explore the barriers to social housing. Thirty-nine sites, either running studies (Sponsors or Contract Research Organisations, CROs) and/or outsourcing work responded to the survey (51% from Europe; 41% from USA). During safety pharmacology studies, 84, 67 and 100% of respondents socially house dogs, minipigs and non-human primates (NHPs) respectively on non-recording days. However, on recording days 20, 20 and 33% of respondents socially house the animals, respectively. The main barriers for social housing were limitations in the recording equipment used, study design and animal temperament/activity. During toxicology studies, 94, 100 and 100% of respondents socially house dogs, minipigs and NHPs respectively on non-recording days. However, on recording days 31, 25 and 50% of respondents socially house the animals, respectively. The main barriers for social housing were risk of damage to and limitations in the recording equipment used, food consumption recording and temperament/activity of the animals. Although the majority of the industry does not yet socially house animals during telemetry recordings in safety pharmacology and toxicology studies, there is support to implement this refinement. Continued discussions, sharing of best practice and data from companies already socially housing, combined with technology improvements and investments in infrastructure are required to maintain the forward momentum of this refinement across the industry. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Adeline du Toit
Full Text Available Purpose: The purpose of this exploratory study was to determine how knowledge workers could align the creation and management of business records with organisational records management needs. Problem investigated: Knowledge workers are employed by more than one organisation at the same time. This creates problems in managing and preserving the business records created and received by knowledge workers. This article investigates how organisations should manage and preserve their business records that are created and received by knowledge workers who are employed by more than one organisation. Methodology: The importance of the management of business records in the knowledge economy was discussed and in the empirical survey data was collected through a questionnaire survey of 122 knowledge workers at an investment management company. Findings: The results of the empirical survey revealed that the majority of respondents always save business records that they create on their own personal filing systems and that they are familiar with the concept of records management. The findings provided support for the hypothesis that knowledge workers take control of managing the business records of various organisations, as their careers consist of a series of projects or assignments, irrespective of the organisation employing them. Value of research: The active role that knowledge workers can play in the management of strategic business records, underlines its key position as an information management function in organisations. Further research is needed to clarify the importance of records management in the knowledge economy. Conclusion: Knowledge workers take control of managing the business records of various organisations, as their careers consist of a series of projects or assignments while working at different organisations.
Rexhepi, Hanife; Åhlfeldt, Rose-Mharie; Cajander, Åsa; Huvila, Isto
Patients' access to their online medical records serves as one of the cornerstones in the efforts to increase patient engagement and improve healthcare outcomes. The aim of this article is to provide in-depth understanding of cancer patients' attitudes and experiences of online medical records, as well as an increased understanding of the complexities of developing and launching e-Health services. The study result confirms that online access can help patients prepare for doctor visits and to understand their medical issues. In contrast to the fears of many physicians, the study shows that online access to medical records did not generate substantial anxiety, concerns or increased phone calls to the hospital.
The Medical & Research Study Records of Human Volunteers System collects demographic and medical information on subjects who participate in research. Learn how this data is collected, used, access to the data, and the purpose of data collection.
Sharma, P. P.; Gervasoni, G.; Albisetti, E.; D'Ercoli, F.; Monticelli, M.; Moretti, D.; Forte, N.; Rocchi, A.; Ferrari, G.; Baldelli, P.; Sampietro, M.; Benfenati, F.; Bertacco, R.; Petti, D.
A promising strategy to get deeper insight on brain functionalities relies on the investigation of neural activities at the cellular and sub-cellular level. In this framework, methods for recording neuron electrical activity have gained interest over the years. Main technological challenges are associated to finding highly sensitive detection schemes, providing considerable spatial and temporal resolution. Moreover, the possibility to perform non-invasive assays would constitute a noteworthy benefit. In this work, we present a magnetoresistive platform for the detection of the action potential propagation in neural cells. Such platform allows, in perspective, the in vitro recording of neural signals arising from single neurons, neural networks and brain slices.
Eric I Benchimol
Full Text Available Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE. The REporting of studies Conducted using Observational Routinely collected health Data (RECORD statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org, will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.
Lezaic, Visnja; Marinkovic, Jelena; Milutinovic, Zoran; Jovanovic-Vasiljevic, Nada; Vujicic, Vesna; Pejovic, Branka; Kalabic, Snezana; Djukanovic, Ljubica
In 2009, Belgrade nephrologists and general practitioners from thirteen health centers carried out screening for chronic kidney disease (CKD). Three years later, medical records of patients from four health centers participating in the screening study were retrospectively analyzed in order to check whether general practitioners had continued to control patients at risk for CKD in accordance with the recommendations provided. The study included 460 patients who visited their doctor at least once in the three-year period. Data on blood pressure, ACEI use, estimated glomerular filtration rate (eGFR) and comorbidities were taken from patients' medical records. Blood pressure was not recorded in any of the three years in 42.8% and eGFR in 36.7% of the patients, but blood pressure was registered every year in 7.8% and eGFR in 4.3% of them. Over the three years, the relative number of patients with recorded blood pressure decreased from 41.7% to 17.8%, and with recorded eGFR from 41.7% to 21.5%. Multivariate linear regression found that Health Center, systolic and diastolic blood pressure and presence of hypertension were negatively associated with number of years with recorded blood pressure. Health Center, systolic blood pressure and sum of years with recorded eGFR below 60 ml/min/1.73m 2 were associated with number of years with recorded eGFR. Under-recording of blood pressure and eGFR in primary care health centers suggests lack of adherence to current guidelines and insufficient care of CKD patients. This implies the necessity for continuous education of physicians.
Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.
The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…
Honda, Yukio; Tanahashi, Kiwamu; Hirayama, Yoshiyuki; Kikukawa, Atsushi; Futamoto, Masaaki
Magnetic force microscopy was used to study the magnetic interaction between the recording and the soft magnetic layers in double-layer perpendicular media by observing the magnetization structure from the soft magnetic layer side. There was a strong magnetic interaction between the recording and the soft magnetic layers. Introducing a thin nonmagnetic intermediate layer between the two layers greatly reduced the magnetic interaction and drastically reduced the medium noise
Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul
Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared
Taylor, Anna; Stapley, Sally; Hamilton, William
Jaundice is a rare but important symptom of malignant and benign conditions. When patients present in primary care, understanding the relative likelihood of different disease processes can help GPs to investigate and refer patients appropriately. To identify and quantify the various causes of jaundice in adults presenting in primary care. Historical cohort study using electronic primary care records. UK General Practice Research Database. Participants (186 814 men and women) aged >45 years with clinical events recorded in primary care records between 1 January 2005 and 31 December 2007. Data were searched for episodes of jaundice and explanatory diagnoses identified within the subsequent 12 months. If no diagnosis was found, the patient's preceding medical record was searched for relevant chronic diseases. From the full cohort, 277 patients had at least one record of jaundice between 1 January 2005 and 31 December 2006. Ninety-two (33%) were found to have bile duct stones; 74 (27%) had an explanatory cancer [pancreatic cancer 34 (12%), cholangiocarcinoma 13 (5%) and other diagnosed primary malignancy 27 (10%)]. Liver disease attributed to excess alcohol explained 26 (9%) and other diagnoses were identified in 24 (9%). Sixty-one (22%) had no diagnosis related to jaundice recorded. Although the most common cause of jaundice is bile duct stones, cancers are present in over a quarter of patients with jaundice in this study, demonstrating the importance of urgent investigation into the underlying cause.
Full Text Available We explore the concept that artists perform best in front of an audience. The negative effects of performance anxiety are much better known than their related cousin on the other shoulder: the positive effects of social facilitation. The present study, however, reveals a listener's preference for performances recorded in front of an audience. In Study 1, we prepared two types of recordings of Träumerei performed by 13 pianists: recordings in front of an audience and those with no audience. According to the evaluation by 153 listeners, the recordings performed in front of an audience sounded better, suggesting that the presence of an audience enhanced or facilitated the performance. In Study 2, we analyzed pianists' durational and dynamic expressions. According to the functional principal components analyses, we found that the expression of Träumerei consisted of three components: the overall quantity, the cross-sectional contrast between the final and the remaining sections, and the control of the expressive variability. Pianists' expressions were targeted more to the average of the cross-sectional variation in the audience-present than in the audience-absent recordings. In Study 3, we explored a model that explained listeners' responses induced by pianists' acoustical expressions, using path analyses. The final model indicated that the cross-sectional variation of the duration and that of the dynamics determined listeners' evaluations of the quality and the emotionally moving experience, respectively. In line with human's preferences for commonality, the more average the durational expressions were in live recording, the better the listeners' evaluations were regardless of their musical experiences. Only the well-experienced listeners (at least 16 years of musical training were moved more by the deviated dynamic expressions in live recording, suggesting a link between the experienced listener's emotional experience and the unique dynamics in
Hanson, Darlene S.
The purpose of this study was to determine the opinions of nurse educators in the state of North Dakota (ND) who were using the academic Electronic Health Record (EHR) known as SimChart. In this dissertation research study, factors that either hindered or facilitated the introduction of SimChart in nursing programs in ND were examined.…
Tannamala, Pavan Kumar; Pulagam, Mahesh; Pottem, Srinivas R; Swapna, B
The purpose of this study was to compare the sagittal condylar angles set in the Hanau articulator by use of a method of obtaining an intraoral protrusive record to those angles found using a panoramic radiographic image. Ten patients, free of signs and symptoms of temporomandibular disorder and with intact dentition were selected. The dental stone casts of the subjects were mounted on a Hanau articulator with a springbow and poly(vinyl siloxane) interocclusal records. For all patients, the protrusive records were obtained when the mandible moved forward by approximately 6 mm. All procedures for recording, mounting, and setting were done in the same session. The condylar guidance angles obtained were tabulated. A panoramic radiographic image of each patient was made with the Frankfurt horizontal plane parallel to the floor of the mouth. Tracings of the radiographic images were made. The horizontal reference line was marked by joining the orbitale and porion. The most superior and most inferior points of the curvatures were identified. These two lines were connected by a straight line representing the mean curvature line. Angles made by the intersection of the mean curvature line and the horizontal reference line were measured. The results were subjected to statistical analysis with a significance level of p record method. The mean condylar guidance angle between the right and left side by both the methods was not statistically significant. The comparison of mean condylar guidance angles between the right side of the protrusive record method and the right side of the panoramic radiographic method and the left side of the protrusive record method and the left side of the panoramic radiographic method (p= 0.071 and p= 0.057, respectively) were not statistically significant. Within the limitations of this study, it was concluded that the protrusive condylar guidance angles obtained by panoramic radiograph may be used in programming semi-adjustable articulators. © 2012
Madden, Kim; Tai, Kerry; Ali, Zak; Schneider, Patricia; Singh, Mahip; Ghert, Michelle; Bhandari, Mohit
Registering study protocols in a trial registry is important for methodologic transparency and reducing selective reporting bias. The objective of this investigation was to determine whether published studies of intimate partner violence (IPV) that had been registered matched the registration record on key study design elements. We systematically searched three trial registries to identify registered IPV studies and the published literature for the associated publication. Two authors independently determined for each study whether key study elements in the registry matched those in the published paper. We included 66 studies published between 2006 and 2017. Nearly half (29/66, 44%) were registered after study completion. Many (26/66, 39%) had discrepancies regarding the primary outcome, and nearly two-thirds (42/66, 64%) had discrepancies in secondary outcomes. Discrepancies in study design were less frequent (13/66, 20%). However, large changes in sample size (26/66, 39%) and discrepancies in funding source (28/66, 42%) were frequently observed. Trial registries are important tools for research transparency and identifying and preventing outcome switching and selective outcome reporting bias. Published IPV studies often differ from their records in trial registries. Researchers should pay close attention to the accuracy of trial registry records.
Fouwels, Annemarie J.; Bredie, Sebastiaan J. H.; Wollersheim, Hub; Schippers, Gerard M.
ABSTRACT: BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of
Fouwels, A.J.; Bredie, S.J.H.; Wollersheim, H.C.H.; Schippers, G.M.
BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the
... fully meet the criteria for national historic trails. The overall nature of public comments during the... support the no action alternative as the selected action is based on the lack of support for designation... Record of Decision because the study involved no park resources. FOR FURTHER INFORMATION CONTACT: Sharon...
Dollar, Charles M.
This study is a review of trends in information-handling technology and significant developments which are changing or will change the general environment within which archivists and records managers in international organizations will have to work. Trends in microelectronics, electronic storage, software, data transmission, computer architecture,…
Zhang, Yin; Salaba, Athena
This article reports on a Delphi study conducted to determine key issues and challenges facing Functional Requirements for Bibliographic Records (FRBR) research and practice. The Delphi panel consisted of thirty-three experts in the field who participated in a three-round issue-raising and consensus-building process via a Web-based survey…
Gromik, Nicolas A.
This paper reports on a case study conducted at a Japanese national university. Nine participants used the video recording feature on their cell phones to produce weekly video productions. The task required that participants produce one 30-second video on a teacher-selected topic. Observations revealed the process of video creation with a cell…
Telegin, A.N.; Bulatov, M.G.
An algorithm is proposed for determining effective velocities in the process of diffraction transformation of seismic waves. It is based on summation with conjugate recordings. Results of the study of velocities are indicated in materials of Sakhalin. A difference is noted in the procedures for computing effective velocities in the OGT method and diffraction transformation.
Adekunle Yisau Abdulkadir
Full Text Available AIM: With the background knowledge that auditing of Medical Records (MR for adequacy and completeness is necessary if it is to be useful and reliable in continuing patient care; protection of the legal interest of the patient, physicians, and the Hospital; and meeting requirements for researches, we scrutinized theatre records of our hospital to identify routine omissions or deficiencies, and correctable errors in our MR system. METHOD: Obstetrics and Gynaecological post operation theatre records between January 2006 and December 2008 were quantitatively and qualitatively analyzed for details that included: hospital number; Patients age; diagnosis; surgery performed; types and modes of anesthesia; date of surgery; patients ward; Anesthetists names; surgeons and attending nurses names, and abbreviations used with SPSS 15.0 for Windows. RESULTS: Hardly were any of the 1270 surgeries during the study period documented without an omission or an abbreviation. Hospital numbers and patients age were not documented in 21.8% (n=277 and 59.1% (n=750 respectively. Diagnoses and surgeries were recorded with varying abbreviations in about 96% of instances. Surgical team names were mostly abbreviated or initials only given. CONCLUSION: To improve the quality of Paper-based Medical Record, regular auditing, training and good orientation of medical personnel for good record practices, and discouraging large volume record book to reduce paper damages and sheet loss from handling are necessary else what we record toady may neither be useful nor available tomorrow. [TAF Prev Med Bull 2010; 9(5.000: 427-432
Full Text Available With the accelerated implementation of e-learning systems in educational institutions, it has become possible to record learners’ study logs in recent years. It must be admitted that little research has been conducted upon the analysis of the study logs that are obtained. In addition, there is no software that traces the mouse movements of learners during their learning processes, which the authors believe would enable teachers to better understand their students’ behaviors. The objective of this study is to develop a Web application that records students’ study logs, including their mouse trajectories, and to devise an IR tool that can summarize such diversified data. The results of an experiment are also scrutinized to provide an analysis of the relationship between learners’ activities and their study logs.
Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn
Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a
Roy, Sabyasachi; Wang, Xiaoqin
The ability to record well-isolated action potentials from individual neurons in naturally behaving animals is crucial for understanding neural mechanisms underlying natural behaviors. Traditional neurophysiology techniques, however, require the animal to be restrained which often restricts natural behavior. An example is the common marmoset (Callithrix jacchus), a highly vocal New World primate species, used in our laboratory to study the neural correlates of vocal production and sensory feedback. When restrained by traditional neurophysiological techniques marmoset vocal behavior is severely inhibited. Tethered recording systems, while proven effective in rodents pose limitations in arboreal animals such as the marmoset that typically roam in a three-dimensional environment. To overcome these obstacles, we have developed a wireless neural recording technique that is capable of collecting single-unit data from chronically implanted multi-electrodes in freely moving marmosets. A lightweight, low power and low noise wireless transmitter (headstage) is attached to a multi-electrode array placed in the premotor cortex of the marmoset. The wireless headstage is capable of transmitting 15 channels of neural data with signal-to-noise ratio (SNR) comparable to a tethered system. To minimize radio-frequency (RF) and electro-magnetic interference (EMI), the experiments were conducted within a custom designed RF/EMI and acoustically shielded chamber. The individual electrodes of the multi-electrode array were periodically advanced to densely sample the cortical layers. We recorded single-unit data over a period of several months from the frontal cortex of two marmosets. These recordings demonstrate the feasibility of using our wireless recording method to study single neuron activity in freely roaming primates. Copyright © 2011 Elsevier B.V. All rights reserved.
English Dallas R
Full Text Available Abstract Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables. Methods A sample of 2000 participants from a cohort study (n = 41 514 was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review. Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%. Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.
Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh
In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.
Medication errors are a major source of preventable morbidity, mortality and cost and many occur at the times of hospital admission and discharge. Novel interventions (such as new methods of recording medication information and conducting medication reconciliation) are required to facilitate accurate transfer of medication information. With existing evidence supporting the use of information technology and the patient representing the one constant in the care process, an electronic patient held medication record may provide a solution. This study will assess the feasibility of introducing a patient held electronic medication record in primary and secondary care using the Consolidated Framework for Implementation Research (CFIR).This feasibility study is a mixed method study of community dwelling older adult patients admitted to an urban secondary care facility comprising a non-randomised intervention and qualitative interviews with key stakeholders. Outcomes of interest include clinical outcomes and process evaluation.This study will yield insights pertaining to feasibility, acceptability and participation for a more definitive evaluation of the intervention. The study also has the potential to contribute to knowledge of implementation of technology in a healthcare context and to the broader area of implementation science.
Ann R R Robertson
Full Text Available Background Globally, diabetes mellitus presents a substantial burden to individuals and healthcare systems. Structuring and/or coding of medical records underpin attempts to improve information sharing and searching, potentially bringing clinical and secondary uses benefits.Aims and objectives We investigated if, how and why records for adults with diabetes were structured and/or coded, and explored stakeholders’ perceptions of current practice.Methods We carried out a qualitative, theoretically-informed case study of documenting healthcare information for diabetes patients in family practice and hospital settings, using semi-structured interviews, observations, systems demonstrations and documentary data.Results We conducted 22 interviews and four on-site observations, and reviewed 25 documents. For secondary uses – research, audit, public health and service planning – the benefits of highly structured and coded diabetes data were clearly articulated. Reported clinical benefits in terms of managing and monitoring diabetes, and perhaps encouraging patient self-management, were modest. We observed marked differences in levels of record structuring and/or coding between settings, and found little evidence that these data were being exploited to improve information sharing between them.Conclusions Using high levels of data structuring and coding in medical records for diabetes patients has potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK.
Giada, Franco; Gulizia, Michele; Francese, Maura; Croci, Francesco; Santangelo, Lucio; Santomauro, Maurizio; Occhetta, Eraldo; Menozzi, Carlo; Raviele, Antonio
The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations. In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis. We studied 50 patients with infrequent (1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated. A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (euro 3,056 +/- euro 363 vs. euro 6,768 +/- euro 6,672, p = 0.012). In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.
Construction of the database system aimed at multipurpose application of data on clinical medicine was studied through the preparation of database system for clinical records of atomic bomb survivors. The present database includes the data about 110,000 atomic bomb survivors in Nagasaki City. This study detailed: (1) Analysis of errors occurring in a period from generation of data in the clinical field to input into the database, and discovery of a highly precise, effective method of input. (2) Development of a multipurpose program for uniform processing of data on physical examinations from many organizations. (3) Development of a record linkage method for voluminous files which are essential in the construction of a large-scale medical information system. (4) A database model suitable for clinical research and a method for designing a segment suitable for physical examination data. (Chiba, N.)
Robertson, Ann R R; Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz
Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management. We sought to investigate if how and why records for adults with diabetes were structured and coded and to explore a range of UK stakeholders' perceptions of current practice in the National Health Service. We carried out a qualitative, theoretically informed case study of documenting health care information for diabetes in family practice and hospital settings in England, using semi-structured interviews, observations, systems demonstrations and documentary data. We conducted 22 interviews and four on-site observations. With respect to secondary uses - research, audit, public health and service planning - interviewees clearly articulated the benefits of highly structured and coded diabetes data and it was believed that benefits would expand through linkage to other datasets. Direct, more marginal, clinical benefits in terms of managing and monitoring diabetes and perhaps encouraging patient self-management were also reported. We observed marked differences in levels of record structuring and/or coding between family practices, where it was high, and the hospital. We found little evidence that structured and coded data were being exploited to improve information sharing between care settings. Using high levels of data structuring and coding in records for diabetes patients has the potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK. A first step would be for hospitals to attain levels of health information technology infrastructure and systems use commensurate with family practices.
Zivin, Kara; White, Jessica O; Chao, Sandra; Christensen, Anna L; Horner, Luke; Petersen, Dana M; Hobbs, Morgan R; Capreol, Grace; Halbritter, Kevin A; Jones, Christopher M
To pilot test the effectiveness, feasibility, and acceptability of instituting a 15-pill quantity default in the electronic health record for new Schedule II opioid prescriptions. A mixed-methods pilot study in two health systems, including pre-post analysis of prescribed opioid quantity and focus groups or interviews with prescribers and health system administrators. We implemented a 15-pill electronic health record default for new Schedule II opioids and assessed opioid quantity before and after implementation using electronic health record data on 6,390 opioid prescriptions from 448 prescribers. We then analyzed themes from focus groups and interviews with four staff members and six prescribers. The proportion of opioid prescriptions for 15 pills increased at both sites after adding an electronic health record default, with one reaching statistical significance (from 4.1% to 7.2% at CHC, P = 0.280, and 15.9% to 37.2% at WVU, P default, although ease of implementation varied by electronic health record vendor. Most prescribers were not aware of the default change and stated that they made prescribing decisions based on patient clinical characteristics rather than defaults. This pilot provides initial evidence that changing default settings can increase the number of prescriptions at the default level. This low-cost and relatively simple intervention could have an impact on opioid overprescribing. However, default settings should be selected carefully to avoid unintended consequences. © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: email@example.com
Conclusions Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector.
This report summarises the results of a pilot study aimed at investigating the potential of using dinoflagellate cyst (dinocyst) records in the New Zealand region for contributing to high-resolution Quaternary climate studies. Dinocyst assemblages were recorded through a rapid interval of climate change, from glacial Marine Isotope Stage (MIS) 6 to interglacial MIS 5 (∼ 160 to 80 kyr), in ODP Site 1123, offshore eastern New Zealand. Twenty-one samples were examined and dinocyst assemblages, along with other palynomorphs such as spores and pollen, were generally well preserved, abundant and diverse. The relative and absolute abundance of dinocysts is highest in MIS 6, with Brigantedinium spp. and Nematosphaeropsis labyrinthus being the dominant taxa. Moreover, the higher concentration of peridinioid and total dinocysts during the glacial suggests that, in comparison with MIS 5, increased nutrient availability in surface waters was present in MIS 6. Other dinocysts that show an affinity with cool oceanic conditions include Impagidinium pallidum and Selenopemphix Antarctica, while Impagidinium paradoxum, I. patulum, I. plicatum, I. strialatum, I. variaseptum and Spiniferites mirabilis are more common during the interglacial MIS 5. Land-derived spore and pollen microfossils are abundant in Site 1123 and notable peaks in absolute abundance are recorded during MIS 5, with two of the peaks being approximately coeval with the warmer phases of Substage 5e and 5a. This pilot study highlights the increasing potential for marine palynology to contribute to Quaternary paleoclimate research in the New Zealand region. (author). 45 refs., 10 figs
Full Text Available As a part of pre-implementation of Electronic Health Record (EHR as communicating tool, the study aims at investigating the awareness, perception, and usability of EHR among nurses working in 2032 bedded hospital in southern India. A cross sectional descriptive study with convenient sampling method of 296 nurses was used. The validated questionnaire contained questions related to perception of the nurses about the existing system of record keeping and their effect on patient care; Usefulness of EMR for their practice; relative important of features of EMR; acceptance level and training needs. For analysis SPSS 10.0 version was used. The results of this study is promising in terms of nurses’ views for adoption of EHR. Also, suggests, nurses are beginning to perceive benefits in areas of quality in decision making; patient care and practice; enhance timely access to medical records; efficiency; productivity. Strategies are needed for improving the EHR knowledge among nurses who have a negative perception of and attitude towards it.
Jorge J. Cherem
Full Text Available Studies to evaluate environmental impacts have become both a need and a requirement of environmental agencies due to great alteration of the native environments provoked by man. Many of these studies are short-termed, but reporting the acquired data is very important in order to increase knowledge about specific biotic groups. Thus, this paper presents the results of the non-volant mammal surveys arising from seven environmental studies in southern Brazil. The following methodologies were employed: (1 interviews with local residents; (2 visual observations and recording; (3 identification of vestiges; and (4 capture with live traps. A total of 46 mammal species were recorded (5 marsupials, 4 xenarthrans, 2 primates, 13 carnivores, 2 artiodactylans, 2 lagomorphs and 18 rodents. Some species, such as the jaguar (Panthera onca, giant otter (Pteronura brasiliensis, Brazilian tapir (Tapirus terrestris and white-lipped peccary (Tayassu pecari, are possibly extinct or seriously threatened. The records obtained and the possibilities of the occurrence of other species are discussed.
Robie, D.M.; Fry, S.A.
The availability of computers with increasing capabilities has made feasibile epidemiologic studies involving large populations such as those utilized to evaluate the health effects of occupational exposure to radiation. However, the storage and retrieval of data from the large numbers of hard-copy personnel, health physics, employment medical, historical or anecdotal documents that are the bases of such studies pose major logistics problems to investigators. The potential value of such records to epidemiologic studies depends, not only on their accuracy and completeness, but also on ease of accessibility. To address the latter problem, we are using a stand-alone user-oriented electronic filing system that records, stores, and secures hard-copy documents micrographically. This system is controlled by a computer that provides retrieval of a document image and printed copy (if desired) in less than 30 seconds from a maximum of eight fields. One thousand documents are randomly filmed and indexed on computer storage diskettes in two hours. Manual sorting and filing of the same number of documents takes over a day. At present two thousand documents can be recorded on each microfilm roll and 85,000 documents indexed on each diskette. Simultaneous searching for documents can be done using up to ten terminals while indexing is being done at the main terminal. The micrographics system provides the space-saving and security advantages of microfilm with the speed of computerized data retrieval
National Oceanic and Atmospheric Administration, Department of Commerce — Phenology is the scientific study of periodic biological phenomena, such as flowering, breeding, and migration, in relation to climatic conditions. The few records...
Salvermoser, Johannes; Stähler, Simon; Hadziioannou, Céline
Civil structures age continuously. The early recognition of potentially critical damages is an important economical issue, but also one of public safety. Continuous tracking of small changes in the medium by using passive methods would offer an extension to established active non-destructive testing procedures at relatively low cost. Here we present a case study of structural monitoring using continuous recordings of traffic noise on a 200 meter long reinforced concrete highway bridge in Germany. Over two months of continuos geophone records are used in the frequency range of 2-8 Hz. Using passive image interferometry, evaluation of hourly cross-correlations between recordings at pairs of receivers yield velocity variations in the range of -1.5% to +2.1%. We were able to correlate our outcomes with temperature measurements of the same two month period. The measured velocity changes scale with the temperature variations with on average a dv/v of 0.064% per degree Celsius. This value is in accordance with other studies of concrete response to temperature, confirming that we are able to observe subtle changes with physical origin. It is shown that traffic noise is temporally homogenenous enough to fulfill the requirements of passive image interferometry.
Full Text Available Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3 but not in either of the controls (−2.0 to −0.3%. The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2 and 33.7% (26.6–41.3. The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.
Flørenes, T W; Nordsletten, L; Heir, S; Bahr, R
No long-term injury surveillance programs exist for competitive skiing or snowboarding. The objective of this study was, therefore, to compare different methods to record injuries among World Cup athletes in alpine, freestyle, and cross-country skiing, snowboarding, ski jumping and Nordic combined. Information regarding injuries sustained during the 2006-2007 winter season was recorded through three separate and independent systems: prospective injury reports by technical delegates (TD) from the International Ski Federation, prospective medical team registration by selected teams, and retrospective athlete interviews at the end of the season. A total of 100 unique injuries to 602 World Cup athletes were identified from any of the three recording methods. Of these, 91% were registered through the athlete interviews, 47% by the medical team registration and 27% by the TD reports. Only 20 injuries (20%) were captured by all three methods. A total of 64 time-loss injuries were registered. The interviews captured 60 (94%), the medical team registration 39 (61%), and the TD reports 23 (36%) time-loss injuries, while 18 (28%) were registered by all three systems. Retrospective interviews with athletes/coaches regarding injuries during the last 6 months gave the most complete picture of injuries to World Cup skiers and snowboarders. © 2009 John Wiley & Sons A/S.
Kim, Ki Hoon; Park, Byung Kyu; Kim, Dong Hwee; Kim, Yuntae
We sought to establish the optimal recording position for antidromic conduction of the superficial peroneal nerve (SPN) by using ultrasonography (USG). The sensory nerve action potentials (SNAPs) of the intermediate dorsal cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (MDCN) in 64 limbs of 32 healthy participants were recorded (nerve conduction study [NCS]-1). Both nerves were identified by using USG, and the SNAPs were obtained from the USG-guided repositioned electrodes (NCS-2). The IDCN and MDCN were located at 29.3% ± 5.1% and 43.9% ± 4.9% of the intermalleolar distance from the lateral malleolus, respectively. Significantly greater amplitude was shown for SNAPs of both nerves in NCS-2 versus NCS-1. The optimal recording position is likely to be lateral, one-third from the lateral malleolus for the IDCN, and just lateral to the midpoint of the intermalleolar line for the MDCN. When the SPN response is unexpectedly attenuated, USG-guided repositioning of the electrodes should be considered. Muscle Nerve 57: 628-633, 2018. © 2017 Wiley Periodicals, Inc.
Chen, Chang Hao; McCullagh, Elizabeth A; Pun, Sio Hang; Mak, Peng Un; Vai, Mang I; Mak, Pui In; Klug, Achim; Lei, Tim C
The ability to record and to control action potential firing in neuronal circuits is critical to understand how the brain functions. The objective of this study is to develop a monolithic integrated circuit (IC) to record action potentials and simultaneously control action potential firing using optogenetics. A low-noise and high input impedance (or low input capacitance) neural recording amplifier is combined with a high current laser/light-emitting diode (LED) driver in a single IC. The low input capacitance of the amplifier (9.7 pF) was achieved by adding a dedicated unity gain stage optimized for high impedance metal electrodes. The input referred noise of the amplifier is [Formula: see text], which is lower than the estimated thermal noise of the metal electrode. Thus, the action potentials originating from a single neuron can be recorded with a signal-to-noise ratio of at least 6.6. The LED/laser current driver delivers a maximum current of 330 mA, which is adequate for optogenetic control. The functionality of the IC was tested with an anesthetized Mongolian gerbil and auditory stimulated action potentials were recorded from the inferior colliculus. Spontaneous firings of fifth (trigeminal) nerve fibers were also inhibited using the optogenetic protein Halorhodopsin. Moreover, a noise model of the system was derived to guide the design. A single IC to measure and control action potentials using optogenetic proteins is realized so that more complicated behavioral neuroscience research and the translational neural disorder treatments become possible in the future.
Bouamrane, Matt-Mouley; Mair, Frances S
Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.
Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris
The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a
Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana
infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.
Kerai, Paresh; Wood, Pene; Martin, Mary
Australia introduced its version of personal health records in July 2012. Success of the personally controlled electronic health record (PCEHR) relies on acceptance during the early stages. The main aim of this study was to investigate the views of a sample of elderly people in a non-metropolitan region in Australia on the PCEHR, and to assess their acceptance levels of this concept. A self-administered questionnaire was distributed to a non-probability convenience sample of respondents recruited from meetings of Probus, a community club for active business and professional retirees. Approximately three-quarters of the respondents had computer and Internet access at home. If not accessed at home a computer at a general practitioner's practice was seen as beneficial in accessing the PCEHR. Respondents felt that access to their health record would help them make decisions about their own health and improve their communication with healthcare providers. The majority of respondents were in favour of the PCEHR although some expressed concerns about the security of their PCEHR. There was mixed opinion surrounding the access by health professionals to an individual's PCEHR. This study has revealed important information about views of the PCEHR. While the respondents were generally in favour of the concept, there were still some concerns about the security of the PCEHR suggesting further reassurance may be required. The study also highlighted some measures, in particular provision of General Practitioner computer access points and print-out facilities that may need to be considered during these initial implementation stages in order to improve adoption rates once the technology is fully available. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Glicksberg, Benjamin S; Johnson, Kipp W; Dudley, Joel T
Precision medicine can utilize new techniques in order to more effectively translate research findings into clinical practice. In this article, we first explore the limitations of traditional study designs, which stem from (to name a few): massive cost for the assembly of large patient cohorts; non-representative patient data; and the astounding complexity of human biology. Second, we propose that harnessing electronic health records and mobile device biometrics coupled to longitudinal data may prove to be a solution to many of these problems by capturing a "real world" phenotype. We envision that future biomedical research utilizing more precise approaches to patient care will utilize continuous and longitudinal data sources.
Agnihotri, R.; Kurian, S.
stream_size 72460 stream_content_type text/plain stream_name Earth_Sci_India_1_258.pdf.txt stream_source_info Earth_Sci_India_1_258.pdf.txt Content-Encoding UTF-8 Content-Type text/plain; charset=UTF-8 Agnihotri http://www....earthscienceindia.info/Agnihotri.htm 1 of 14 10/15/2008 9:41 AM Earth Science India Vol.1 (IV), October, 2008, pp. 258-287 http://www.earthscienceindia.info/ Recently studied sedimentary records from the eastern Arabian Sea: Implications to Holocene monsoonal variability Rajesh...
Patzwald, Gari-Anne; Wildt, Sister Carol Marie
The School Sisters of Notre Dame (SSND) archives program in a cooperative system for the arrangement and preservation of the records of the SSND provinces in North America, including records of individual sisters. Archival records include autobiographies, school and college transcripts, employment histories, and family socioeconomic data. The Nun Study, a longitudinal study of Alzheimer's disease and aging in 678 SSND sisters, compares data extracted from these records with data on late-life cognitive and physical function and postmortem brain neuropathology to explore early life factor that may affect late-life cognitive function and longevity.
Jaarsveld, C.H.M. van; Gulliford, M.C.
OBJECTIVE: This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. DESIGN: Cohort study of primary care electronic health records. SETTING: 375 general
Dhollander, S.; Jallow, A.; Mbodge, K.; Kora, S.; Sanneh, M.; Gaye, M.; Bos, J.F.F.P.; Leak, S.; Berkvens, D.; Geerts, S.
The objective of this,study was to provide epidemiological information of equine trypanosomosis in the Central River Division (CRD) of The Gambia. Therefore, 2285 consultations records of equines, admitted in a gate-clinic at Sololo in CRD, were studied retrospectively. The data were recorded in the
Paul Zhihao eYONG
Full Text Available We investigated the testing effect in Coursera video-based learning. One hundred and twenty-three participants either (a studied an instructional video-recorded lecture four times, (b studied the lecture three times and took one recall test, or (c studied the lecture once and took three tests. They then took a final recall test, either immediately or a week later, through which their learning was assessed. Whereas repeated studying produced better recall performance than did repeated testing when the final test was administered immediately, testing produced better performance when the final test was delayed until a week after. The testing effect was observed using Coursera lectures. Future directions are documented.
Carr, Vaughan J; Harris, Felicity; Raudino, Alessandra; Luo, Luming; Kariuki, Maina; Liu, Enwu; Tzoumakis, Stacy; Smith, Maxwell; Holbrook, Allyson; Bore, Miles; Brinkman, Sally; Lenroot, Rhoshel; Dix, Katherine; Dean, Kimberlie; Laurens, Kristin R; Green, Melissa J
The initial aim of this multiagency, multigenerational record linkage study is to identify childhood profiles of developmental vulnerability and resilience, and to identify the determinants of these profiles. The eventual aim is to identify risk and protective factors for later childhood-onset and adolescent-onset mental health problems, and other adverse social outcomes, using subsequent waves of record linkage. The research will assist in informing the development of public policy and intervention guidelines to help prevent or mitigate adverse long-term health and social outcomes. The study comprises a population cohort of 87,026 children in the Australian State of New South Wales (NSW). The cohort was defined by entry into the first year of full-time schooling in NSW in 2009, at which time class teachers completed the Australian Early Development Census (AEDC) on each child (with 99.7% coverage in NSW). The AEDC data have been linked to the children's birth, health, school and child protection records for the period from birth to school entry, and to the health and criminal records of their parents, as well as mortality databases. Descriptive data summarising sex, geographic and socioeconomic distributions, and linkage rates for the various administrative databases are presented. Child data are summarised, and the mental health and criminal records data of the children's parents are provided. In 2015, at age 11 years, a self-report mental health survey was administered to the cohort in collaboration with government, independent and Catholic primary school sectors. A second record linkage, spanning birth to age 11 years, will be undertaken to link this survey data with the aforementioned administrative databases. This will enable a further identification of putative risk and protective factors for adverse mental health and other outcomes in adolescence, which can then be tested in subsequent record linkages. Published by the BMJ Publishing Group Limited. For
Savica, R; Carlin, J M; Grossardt, B R; Bower, J H; Ahlskog, J E; Maraganore, D M; Bharucha, A E; Rocca, W A
Parkinson disease (PD) may affect the autonomic nervous system and may cause constipation; however, few studies have explored constipation preceding the motor onset of PD. We investigated constipation preceding PD using a case-control study design in a population-based sample. Using the medical records-linkage system of the Rochester Epidemiology Project, we identified 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control. We reviewed the complete medical records of cases and controls in the medical records-linkage system to ascertain the occurrence of constipation preceding the onset of PD (or index year). Constipation preceding PD or the index year was more common in cases than in controls (odds ratio [OR] 2.48; 95% confidence interval [CI] 1.49 to 4.11; p = 0.0005). This association remained significant after adjusting for smoking and coffee consumption (ever vs never), and after excluding constipation possibly induced by drugs. In addition, the association remained significant in analyses restricted to constipation documented 20 or more years before the onset of motor symptoms of PD. Although the association was stronger in women than in men and in patients with PD with rest tremor compared with patients with PD without rest tremor, these differences were not significant. Our findings suggest that constipation occurring as early as 20 or more years before the onset of motor symptoms is associated with an increased risk of Parkinson disease.
Martinez-Laguna, Daniel; Soria-Castro, Alberto; Carbonell-Abella, Cristina; Orozco-López, Pilar; Estrada-Laza, Pilar; Nogues, Xavier; Díez-Perez, Adolfo; Prieto-Alhambra, Daniel
Electronic medical records databases use pre-specified lists of diagnostic codes to identify fractures. These codes, however, are not specific enough to disentangle traumatic from fragility-related fractures. We report on the proportion of fragility fractures identified in a random sample of coded fractures in SIDIAP. Patients≥50 years old with any fracture recorded in 2012 (as per pre-specified ICD-10 codes) and alive at the time of recruitment were eligible for this retrospective observational study in 6 primary care centres contributing to the SIDIAP database (www.sidiap.org). Those with previous fracture/s, non-responders, and those with dementia or a serious psychiatric disease were excluded. Data on fracture type (traumatic vs fragility), skeletal site, and basic patient characteristics were collected. Of 491/616 (79.7%) patients with a registered fracture in 2012 who were contacted, 331 (349 fractures) were included. The most common fractures were forearm (82), ribs (38), and humerus (32), and 225/349 (64.5%) were fragility fractures, with higher proportions for classic osteoporotic sites: hip, 91.7%; spine, 87.7%; and major fractures, 80.5%. This proportion was higher in women, the elderly, and patients with a previously coded diagnosis of osteoporosis. More than 4 in 5 major fractures recorded in SIDIAP are due to fragility (non-traumatic), with higher proportions for hip (92%) and vertebral (88%) fracture, and a lower proportion for fractures other than major ones. Our data support the validity of SIDIAP for the study of the epidemiology of osteoporotic fractures. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Söderlindh, Stefan; Broman, David
The purpose of this thesis is to describe and analyze how the online vinyl record network functions from both a consumer and retailer perspective, in order to gain an understanding of how the Internet facilitates the activity within a consumer culture. The vinyl record industry is experiencing a revival, with an upswing in sales and media attention and a significant increase in the amount of online trading. This inductive study contains data from qualitative interviews with ten vinyl record c...
Full Text Available Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially true in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral syncrhony (SBS. High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrical stimulation. She was submitted to a right frontal lobe resection, 1.5 cm ahead of the motor strip and has been seizure free since surgery (8 months. Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.
Miah, Shah Jahan; Samsudin, Ahmad Zam Hariro
Higher education institutes such as universities suffer from a range of issues in managing their academic records and relevant digital contents. Many universities nowadays use specific software applications for their effective mechanism in records management. The effective provision of enterprises records management (ERM) software for managing…
Dumay, A.C.M.; Haaker, T.I.
Background: A locum practitioner is an out-of-hours general practitioner who needs access to the electronic health record of visiting patients. The electronic locum record is a summary of the electronic health record available to the locum practitioner and includes the most significant health
Katherine I Morley
Full Text Available National electronic health records (EHR are increasingly used for research but identifying disease cases is challenging due to differences in information captured between sources (e.g. primary and secondary care. Our objective was to provide a transparent, reproducible model for integrating these data using atrial fibrillation (AF, a chronic condition diagnosed and managed in multiple ways in different healthcare settings, as a case study.Potentially relevant codes for AF screening, diagnosis, and management were identified in four coding systems: Read (primary care diagnoses and procedures, British National Formulary (BNF; primary care prescriptions, ICD-10 (secondary care diagnoses and OPCS-4 (secondary care procedures. From these we developed a phenotype algorithm via expert review and analysis of linked EHR data from 1998 to 2010 for a cohort of 2.14 million UK patients aged ≥ 30 years. The cohort was also used to evaluate the phenotype by examining associations between incident AF and known risk factors.The phenotype algorithm incorporated 286 codes: 201 Read, 63 BNF, 18 ICD-10, and four OPCS-4. Incident AF diagnoses were recorded for 72,793 patients, but only 39.6% (N = 28,795 were recorded in primary care and secondary care. An additional 7,468 potential cases were inferred from data on treatment and pre-existing conditions. The proportion of cases identified from each source differed by diagnosis age; inferred diagnoses contributed a greater proportion of younger cases (≤ 60 years, while older patients (≥ 80 years were mainly diagnosed in SC. Associations of risk factors (hypertension, myocardial infarction, heart failure with incident AF defined using different EHR sources were comparable in magnitude to those from traditional consented cohorts.A single EHR source is not sufficient to identify all patients, nor will it provide a representative sample. Combining multiple data sources and integrating information on treatment and
The purpose of this guide is to describe each series of records that pertains to the epidemiologic studies conducted by the Epidemiology Section of the Occupational Medicine Group (ESH-2) at the Department of Energy`s (DOE) Los Alamos National Laboratory (LANL) in Los Alamos, New Mexico. The records described in this guide relate to occupational studies performed by the Epidemiology Section, including those pertaining to workers at LANL, Mound Plant, Oak Ridge Reservation, Pantex Plant, Rocky Flats Plant, and Savannah River Site. Also included are descriptions of other health-related records generated or collected by the Epidemiology Section and a small set of records collected by the Industrial Hygiene and Safety Group. This guide is not designed to describe the universe of records generated by LANL which may be used for epidemiologic studies of the LANL work force. History Associates Incorporated (HAI) prepared this guide as part of its work as the support services contractor for DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of LANL the history and functions of LANL`s Health Division and Epidemiology Section, and the various epidemiologic studies performed by the Epidemiology Section. It provides information on the methodology that HAI used to inventory and describe records housed in the offices of the LANL Epidemiology Section in Technical Area 59 and at the LANL Records Center. Other topics include the methodology used to produce the guide, the arrangement of the detailed record series descriptions, and information concerning access to records repositories.
Full Text Available Microbialites are sedimentary formations that are found throughout the geological record and are usually considered as one of the oldest traces of life on Earth. Although they have been known for more than a century and hold as an emblematic object in Earth Sciences, we yet do not understand in details how they form and how microbial processes impact their chemistry, structure and macroscopic morphology. Here, we show recent advances achieved owing to funding provided by the EPOV program on the formation of modern microbialites in the crater Lake Alchichica (Mexico. We first show that very diverse microbial communities populate these microbialites, including diverse microbial groups able to induce carbonate precipitation. We demonstrate that this microbial diversity can be preserved for several years in laboratory aquaria offering a nice opportunity for future studies to assess the relationships between biodiversity and microbialite formation. We then detail the textural modifications affecting cyanobacterial cells during the first steps of fossilization as captured in Alchichica microbialites. Finally, we report the discovery of a new deepbranching cyanobacterium species, Candidatus Gloeomargarita lithophora, able to form intracellular Ca-, Mg-, Sr- and Ba-rich carbonates and discuss the implications for the interpretation of the fossil record.
Patel, Mehul D; Rose, Kathryn M; Owens, Cindy R; Bang, Heejung; Kaufman, Jay S
Occupational data are a common source of workplace exposure and socioeconomic information in epidemiologic research. We compared the performance of two occupation coding methods, an automated software and a manual coder, using occupation and industry titles from U.S. historical records. We collected parental occupational data from 1920-40s birth certificates, Census records, and city directories on 3,135 deceased individuals in the Atherosclerosis Risk in Communities (ARIC) study. Unique occupation-industry narratives were assigned codes by a manual coder and the Standardized Occupation and Industry Coding software program. We calculated agreement between coding methods of classification into major Census occupational groups. Automated coding software assigned codes to 71% of occupations and 76% of industries. Of this subset coded by software, 73% of occupation codes and 69% of industry codes matched between automated and manual coding. For major occupational groups, agreement improved to 89% (kappa = 0.86). Automated occupational coding is a cost-efficient alternative to manual coding. However, some manual coding is required to code incomplete information. We found substantial variability between coders in the assignment of occupations although not as large for major groups.
Tristan L Guttridge
Full Text Available Group behaviours are widespread among fish but comparatively little is known about the interactions between free-ranging individuals and how these might change across different spatio-temporal scales. This is largely due to the difficulty of observing wild fish groups directly underwater over long enough time periods to quantify group structure and individual associations. Here we describe the use of a novel technology, an animal-borne acoustic proximity receiver that records close-spatial associations between free-ranging fish by detection of acoustic signals emitted from transmitters on other individuals. Validation trials, held within enclosures in the natural environment, on juvenile lemon sharks Negaprion brevirostris fitted with external receivers and transmitters, showed receivers logged interactions between individuals regularly when sharks were within 4 m ( approximately 4 body lengths of each other, but rarely when at 10 m distance. A field trial lasting 17 days with 5 juvenile lemon sharks implanted with proximity receivers showed one receiver successfully recorded association data, demonstrating this shark associated with 9 other juvenile lemon sharks on 128 occasions. This study describes the use of acoustic underwater proximity receivers to quantify interactions among wild sharks, setting the scene for new advances in understanding the social behaviours of marine animals.
Fauser, Susanne; Schulze-Bonhage, Andreas
Hippocampal sclerosis is often associated with macroscopic or microscopic dysplasia in the temporal neocortex (TN). The relevance of such a dual pathology with regard to epileptogenesis is unclear. This study investigates the role of both pathologies in the generation of ictal and interictal activity. Ictal (113 seizures) and interictal data from invasive EEG recordings with simultaneous depth electrodes in the hippocampus and subdural electrodes over the TN were analysed retrospectively in 12 patients with variable degrees of hippocampal sclerosis and different types of histologically confirmed temporal cortical dysplasia [all male, age at epilepsy onset 25 Hz) and repetitive sharp waves. The interictal patterns over the TN were similar to those seen over extratemporal focal cortical dysplasias. Simultaneous recordings from the hippocampus and the TN strongly suggest that dysplastic tissue in the TN is often epileptogenic. The quantitative contribution of the hippocampus to seizure generation corresponded with the degree of hippocampal pathology, whereas different subtypes of cortical dysplasia did not affect its relative contribution to seizure generation and even mild forms of dysplasia were epileptogenic.
Berntsen, S; Richardsen, K R; Mørkrid, K; Sletner, L; Birkeland, K I; Jenum, A K
This study aimed to compare objectively recorded physical activity (PA) levels and walking steps among pregnant women. Cross-sectional data from a multiethnic cohort (n = 823) of pregnant women consisting of 44% from Western countries, 24% from South Asia, 14% from Middle East, and 18% from other countries. PA and steps were recorded by the activity monitor SenseWear™ Pro3 Armband. A total of 678 women were included in the analysis. Western women walked significantly more steps and had higher moderate-to-vigorous-intensity physical activity (MVPA) levels compared with South Asian women per weekday and weekend day. Interaction terms (P = 0.008) between ethnicity (Western vs South Asian) and parity, and education, respectively, were identified: having ≥ 1 children was positively associated with steps during weekends in South Asians in contrast to Western women. Having pregnancy and South Asian women without children and with higher education may have an elevated risk for an inactive lifestyle during pregnancy. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available Ye-Seul Lee,1 Won-Mo Jung,1 Hyunchul Jang,2 Sanghyun Kim,2 Sun-Yong Chung,3 Younbyoung Chae1 1Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, 2Mibyeong Research Center, Korean Institute of Oriental Medicine, Daejeon, 3Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea Objectives: Recently, there has been increasing interest in preventing and managing diseases both inside and outside medical institutions, and these concerns have supported the development of the individual Personal Health Record (PHR. Thus, the current study created a mobile platform called “Mind Mirror” to evaluate psychological and physical conditions and investigated whether PHRs would be a useful tool for assessment of the dynamic relationship between the emotional and physical conditions of an individual.Methods: Mind Mirror was used to collect 30 days of observational data about emotional valence and the physical states of pain and fatigue from 20 healthy participants, and these data were used to analyze the dynamic relationship between emotional and physical conditions. Additionally, based on the cross-correlations between these three parameters, a multilevel multivariate regression model (mixed linear model [MLM] was implemented.Results: The strongest cross-correlation between emotional and physical conditions was at lag 0, which implies that emotion and body condition changed concurrently. In the MLM, emotional valence was negatively associated with fatigue (β =-0.233, P<0.001, fatigue was positively associated with pain (β =0.250, P<0.001, and pain was positively associated with fatigue (β =0.398, P<0.001.Conclusion: Our study showed that emotional valence and one’s physical condition negatively influenced one another, while fatigue and pain positively affected each other. These findings suggest that the mind and body interact instantaneously, in
Greenhalgh, Trisha; Stramer, Katja; Bratan, Tanja; Byrne, Emma; Mohammad, Yara; Russell, Jill
To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale information technology projects in health care. Multi-site, mixed method case study applying utilisation focused evaluation. Four early adopter sites for the SCR in England-three in urban areas of relative socioeconomic deprivation and the fourth in a relatively affluent rural area. Data sources and analysis Data included 250 staff interviews, 1500 hours of ethnographic observation, interviews and focus groups with 170 patients and carers, 2500 pages of correspondence and documentary evidence, and incorporation of relevant surveys and statistics produced by others. These were analysed by using a thematic approach drawing on (and extending) a theoretical model of complex change developed in a previous systematic review. Main findings The mixed fortunes of the SCR programme in its first year were largely explained by eight interacting influences. The first was the SCR's material properties (especially technical immaturity and lack of interoperability) and attributes (especially the extent to which potential adopters believed the benefits outweighed the risks). The second was adopters' concerns (especially about workload and the ethicality of sharing "confidential" information on an implied consent model). The third influence was interpersonal influence (for example, opinion leaders, champions, facilitators), and the fourth was organisational antecedents for innovation (for example past experience with information technology projects, leadership and management capacity, effective data capture systems, slack resources). The fifth was organisational readiness for the SCR (for example, innovation-system fit, tension for change, power balances between supporters and opponents, baseline data quality). The sixth was the implementation process (including the nature of the change model and
Simon, Justin I.; Matzel, J. E. P.; Simon, S. B.; Weber, P. K.; Grossman, L.; Ross, D. K.; Hutcheon, I. D.
Ca-, Al-rich inclusions (CAIs) record the O-isotope composition of Solar nebular gas from which they grew . High spatial resolution O-isotope measurements afforded by ion microprobe analysis across the rims and margin of CAIs reveal systematic variations in (Delta)O-17 and suggest formation from a diversity of nebular environments [2-4]. This heterogeneity has been explained by isotopic mixing between the O-16-rich Solar reservoir  and a second O-16-poor reservoir (probably nebular gas) with a "planetary-like" isotopic composition [e.g., 1, 6-7], but the mechanism and location(s) where these events occur within the protoplanetary disk remain uncertain. The orientation of large and systematic variations in (Delta)O-17 reported by  for a compact Type A CAI from the Efremovka reduced CV3 chondrite differs dramatically from reports by  of a similar CAI, A37 from the Allende oxidized CV3 chondrite. Both studies conclude that CAIs were exposed to distinct, nebular O-isotope reservoirs, implying the transfer of CAIs among different settings within the protoplanetary disk . To test this hypothesis further and the extent of intra-CAI O-isotopic variation, a pristine compact Type A CAI, Ef-1 from Efremovka, and a Type B2 CAI, TS4 from Allende were studied. Our new results are equally intriguing because, collectively, O-isotopic zoning patterns in the CAIs indicate a progressive and cyclic record. The results imply that CAIs were commonly exposed to multiple environments of distinct gas during their formation. Numerical models help constrain conditions and duration of these events.
Mackay, Daniel F; Smith, Gordon C S; Cooper, Sally-Ann; Wood, Rachael; King, Albert; Clark, David N; Pell, Jill P
Learning disabilities have profound, long-lasting health sequelae. Affected children born over the course of 1 year in the United States of America generated an estimated lifetime cost of $51.2 billion. Results from some studies have suggested that autistic spectrum disorder may vary by season of birth, but there have been few studies in which investigators examined whether this is also true of other causes of learning disabilities. We undertook Scotland-wide record linkage of education (annual pupil census) and maternity (Scottish Morbidity Record 02) databases for 801,592 singleton children attending Scottish schools in 2006-2011. We modeled monthly rates using principal sine and cosine transformations of the month number and demonstrated cyclicity in the percentage of children with special educational needs. Rates were highest among children conceived in the first quarter of the year (January-March) and lowest among those conceived in the third (July-September) (8.9% vs 7.6%; P disabilities, and learning difficulties (e.g., dyslexia) and were absent for sensory or motor/physical impairments and mental, physical, or communication problems. Seasonality accounted for 11.4% (95% confidence interval: 9.0, 13.7) of all cases. Some biologically plausible causes of this variation, such as infection and maternal vitamin D levels, are potentially amendable to intervention. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Schoenle, Alexandra; Nitsche, Frank; Werner, Jennifer; Arndt, Hartmut
Microbial eukaryotes play an important role in biogeochemical cycles not only in productive surface waters but also in the deep sea. Recent studies based on metagenomics report deep-sea protistan assemblages totally different from continental slopes and shelf waters. To give an overview about the ciliate fauna recorded from the deep sea we summarized the available information on ciliate occurrence in the deep sea. Our literature review revealed that representatives of the major phylogenetic groups of ciliates were recorded from the deep sea (> 1000 m depth): Karyorelictea, Heterotrichea, Spirotrichea (Protohypotrichia, Euplotia, Oligotrichia, Choreotrichia, Hypotrichia), Armophorea (Armophorida), Litostomatea (Haptoria), Conthreep (Phyllopharyngea incl. Cyrtophoria, Chonotrichia, Suctoria; Nassophorea incl. Microthoracida, Synhymeniida, Nassulida; Colpodea incl. Bursariomorphida, Cyrtolophosidida; Prostomatea; Plagiopylea incl. Plagiopylida, Odontostomatida; Oligohymenophorea incl. Peniculia, Scuticociliatia, Hymenostomatia, Apostomatia, Peritrichia, Astomatia). Species occurring in both habitats, deep sea and shallow water, are rarely found to our knowledge to date. This indicates a high deep-sea specific ciliate fauna. Our own studies of similar genotypes (SSU rDNA and cox1 gene) revealed that two small scuticociliate species (Pseudocohnilembus persalinus and Uronema sp.) could be isolated from surface as well as deep waters (2687 m, 5276 m, 5719 m) of the Pacific. The adaptation to deep-sea conditions was investigated by exposing the ciliate isolates directly or stepwise to different hydrostatic pressures ranging from 1 to 550 atm at temperatures of 2 °C and 13 °C. Although the results indicated no general barophilic behavior, all four isolated strains survived the highest established pressure. A better survival at 550 atm could be observed for the lower temperature. Among microbial eukaryotes, ciliates should be considered as a diverse and potentially
Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati
Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death
Kallio, Jouko; Kauppila, Timo; Suominen, Lasse; Heikkinen, Anna Maria
A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists' visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10). Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%), other diseases of hard tissues of teeth (K03, 14.8%), and diseases of pulp and periapical tissues (K04, 11.4%). Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.
Full Text Available Introduction. A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. Methods. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists’ visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10. Results. Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%, other diseases of hard tissues of teeth (K03, 14.8%, and diseases of pulp and periapical tissues (K04, 11.4%. Conclusions. Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.
Bin, Yu Sun; Cistulli, Peter A; Roberts, Christine L; Ford, Jane B
Sleep apnea in pregnancy is known to adversely affect birth outcomes. Whether in utero exposure to maternal sleep apnea is associated with long-term childhood consequences is unclear. Population-based longitudinal study of singleton infants born during 2002-2012 was conducted using linked birth, hospital, death, developmental, and educational records from New South Wales, Australia. Maternal sleep apnea during pregnancy was identified from hospital records. Outcomes were mortality and hospitalizations up to age 6, developmental vulnerability in the first year of school (aged 5-6 years), and performance on standardized tests in the third year of school (aged 7-9 years). Cox proportional hazards and modified Poisson regression models were used to calculate hazard and risk ratios for outcomes in children exposed to maternal apnea compared with those not exposed. Two hundred nine of 626188 singleton infants were exposed to maternal sleep apnea. Maternal apnea was not significantly associated with mortality (Fisher's exact p = .48), developmental vulnerability (adjusted RR 1.29; 95% CI 0.75-2.21), special needs status (1.58; 0.61-4.07), or low numeracy test scores (1.03; 0.63-1.67) but was associated with low reading test scores (1.55; 1.08-2.23). Maternal apnea significantly increased hospitalizations in the first year of life (adjusted HR 1.81; 95% CI 1.40-2.34) and between the first and sixth birthdays (1.41; 1.14-1.75). This is partly due to admissions for suspected pediatric sleep apnea. Maternal sleep apnea during pregnancy is associated with poorer childhood health. Its impact on developmental and cognitive outcomes warrants further investigation. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail email@example.com.
The introduction of computers into general practice settings has profoundly changed the dynamics of the clinical consultation. Previous research exploring the impact of the computer (in what has been termed the 'triadic' consultation) has shown that computer use and communication between doctor and patient are intricately coordinated and inseparable. Swinglehurst et al. have recently been critical of the ongoing tendency within health communication research to focus on 'the computer' as a relatively simple 'black box', or as a material presence in the consultation. By re-focussing on the electronic patient record (EPR) and conceptualising this as a complex collection of silent but consequential voices, they have opened up new and more nuanced possibilities for analysis. This orientation makes visible a tension between the immediate contingencies of the interaction as it unfolds moment-by-moment and the more standardised, institutional demands which are embedded in the EPR ('dilemma of attention'). In this paper I extend this work, presenting an in-depth examination of how participants in the consultation manage this tension. I used linguistic ethnographic methods to study 54 video recorded consultations from a dataset collected between 2007 and 2008 in two UK general practices, combining microanalysis of the consultation with ethnographic attention to the wider organisational and institutional context. My analysis draws on the theoretical work of Erving Goffman and Mikhail Bakhtin, incorporating attention to the 'here and now' of the interaction as well as an appreciation of the 'distributed' nature of the EPR, its role in hosting and circulating new voices, and in mediating participants' talk and social practices. It reveals - in apparently fleeting moments of negotiation and contestation - the extent to which the EPR shapes the dynamic construction, display and circulation of authority in the contemporary consultation. Copyright © 2014 The Author. Published by
Larsen, Birger; Lioma, Christina; Frommholz, Ingo
Books only represented by brief metadata (book records) are particularly hard to retrieve. One way of improving their retrieval is by extracting retrieval enhancing features from them. This work focusses on scientific (physics) book records. We ask if their technical terminology can be used...
Atomic Energy Commission, Washington, DC.
THE SUCCESSFUL OPERATION OF THE PERMISSIBLE LEVEL CONCEPT OF RADIATION CONTROL NECESSARILY ENTAILS A COMPREHENSIVE SYSTEM UNDER WHICH EXPOSURE MUST BE RECORDED AND EMPLOYEES NOTIFIED OF THEIR EXPOSURE HISTORY. IN AN INVESTIGATION OF RECORD KEEPING NECESSARY TO PROCESS RADIATION CLAIMS, QUESTIONNAIRES OR LETTERS WERE RECEIVED FROM 45 STATE AGENCIES…
Background Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women. Methods This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors. Results A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work. Conclusions Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that
Kaoli Pereira Cavalcante
Full Text Available There have been few taxonomic studies of centric diatoms in lotic freshwater environments in Brazil, especially in terms of those including nanoplanktonic forms, which are often neglected in studies of local floras, because of their small size or confusing taxonomy. This is the first study focusing on centric diatoms in the flora of the state of Bahia, in northeastern Brazil. Plankton and periphyton attached to Eichornia crassipes were collected in the winter of 2009 in the Cachoeira River. The diatoms were analyzed and described under light and electron microscopies. Seventeen infrageneric taxa were identified. Cyclotella was represented by five taxa, and concerning of similarities between diacritical features of species in this genus, their descriptions were thoroughly detailed. This was the first time that Cyclotella atomus var. marina, previously recorded only in coastal areas of Japan and Korea, has been documented in a river in South America. We also identified two diatom taxa previously unrecorded in the flora of Brazil: C. cryptica and C. meduanae. Finally, we present a detailed light, transmission and scanning electron microscopy analysis of Skeletonema potamos, a diatom rarely found in the Brazilian literature.
Gromig, R.; Melles, M.; Wagner, B.; Krastel, S.; Andreev, A.; Fedorov, G.; Just, J.; Wennrich, V.; Savelieva, L.; Subetto, D.; Shumilovskikh, L.
The joint German-Russian project 'PLOT - Paleolimnological Transect' aims to recover lake sediment sequences along a more than 6000 km long longitudinal transect across the Eurasian Arctic in order to study the Late Quaternary climatic and environmental history. The eastern end of the PLOT transect is formed by the well-studied record from Lake El'gygytgyn (NE Siberia). Lake Ladoga (N 60°50' E 31°30') is Europe's largest lake, both by size and volume and forms the westernmost end of the transect. Whereas modern sedimentation as well as the Holocene and Late Glacial history of Lake Ladoga have intensely been studied, the preglacial history of the lake is poorly studied to date by sediment cores drilled in the 1930's. A seismic survey of Lake Ladoga in summer 2013 revealed unconformities in the western lake basin, which may separate preglacial sediments in isolated depressions from Late Glacial and Holocene sediment successions above. A 23 m long sediment core (Co1309) was retrieved from one of these depressions. Core Co1309 was investigated by XRF-scanning, magnetic susceptibility measurements, as well as pollen, grain-size, and bio-geochemical analyses. An age-depth model combining radiocarbon, OSL, and paleomagnetic dates is in progress. Both, the pollen results and the OSL ages from the base of the record indicate a deposition during MIS 5e (Eemian). The well sorted reddish sands from this interval contain dinoflagellates suggesting at least brackish conditions, likely due to the existence of a gateway connecting a precursor of the Baltic Sea with the White Sea via Lake Ladoga. The Late Glacial sequence consists of greyish varved clays of decreasing thickness upwards with sporadically intercalated sand layers. The Holocene sequence is composed of brownish diatomaceous silty clay with minor proportions of sand.
Steel, B. A.; Kucera, M.; Darling, K.
Criticism of molecular clock studies often centres on inadequate calibration and a perceived lack of correlation between reproductive isolation and recognisable morphological evolution. Since many major groups (e.g. birds, mammals, reptiles) have a poor fossil record, it is often difficult to test and refute these limitations. Planktic foraminifera represent an exception to this rule. Deep-sea sediments are super-abundant in foraminifera, and large numbers of specimens and occurrences are easily garnered from Ocean Drilling Programme cores. Planktic foraminifera therefore represent an ideal model group with which to test and refine molecular clock studies. Since the 1990AƒAøAøâ_sA¬Aøâ_zAøs, genetic sequences (principally 18S r-RNA) have been extracted from living planktic foraminifera, and a large genetic library has developed. Our study attempts to contextualise and test molecular data, particularly AƒAøAøâ_sA¬Agenetic studies have suggested that these two AƒAøAøâ_sA¬A<Å"super-speciesAƒAøAøâ_sA¬Aøâ_zAø in fact consist of a number of isolated forms, with contrasting ecologies and longevities, which in Recent and sub-Recent sediments can be distinguished either on the basis of pore ultrastructure (Gl. siphonifera) or test colouration (Gs. ruber). In both cases, molecular clock estimates are indicative of ancient (7-11 Ma) intra-species cryptic divergences, which seem to be considerably older than fossil dates. In particular, the calculated molecular split between the two forms of Gs. ruber (AƒAøAøâ_sA¬A<Å"whiteAƒAøAøâ_sA¬Aøâ_zAø and AƒAøAøâ_sA¬A<Å"pinkAƒAøAøâ_sA¬Aøâ_zAø) of around 11 Ma is considerably discordant with the fossil date of around 0.7 Ma. At first glance, this may appear to be a classic case of molecular over-estimation, often a feature of clock models, especially where, as in the foraminifera, substitution rates may vary widely. However, there is good reason to suspect that fossil range of the
de Winter, Niels J.; Vellekoop, Johan; Vorsselmans, Robin; Golreihan, Asefeh; Petersen, Sierra V.; Meyer, Kyle W.; Speijer, Robert P.; Claeys, Philippe
trace element and stable isotope records allow discussion of the degree to which Pycnodonte shells record their palaeoenvironment and can be used to reconstruct past sea water conditions. Preliminary results indicate that stable isotope and trace element ratios in Pynodonte shells record different seasonally changing sea water conditions in the Maastrichtian and reconstructed temperatures are consistent with results from clumped isotope analysis on the same shells and TEX86 analysis on the surrounding rocks. This multi-proxy study sheds light on the shell structure of Pycnodonte oysters, their chemical signature and growth pattern and investigates the expression of palaeoenvironmental proxies in the pristine shell calcite of these bivalves. This investigation shows the potential of using fossil Pycnodonte bivalves as a new archive for palaeoclimate reconstruction on a seasonal scale over a wide range of palaeolatitudes from the Cretaceous until the Pleistocene. References Huyghe et al. (2015) J. Geol Soc 172.5: 576-587. Videt (2003) Diss. Université Rennes 1. Wisshak, et al. (2009) Deep-Sea Res Pt I 56.3: 374-407.
Full Text Available Depending mostly on voluntarily sent spontaneous reports, pharmacovigilance studies are hampered by low quantity and quality of patient data. Our objective is to improve postmarket safety studies by enabling safety analysts to seamlessly access a wide range of EHR sources for collecting deidentified medical data sets of selected patient populations and tracing the reported incidents back to original EHRs. We have developed an ontological framework where EHR sources and target clinical research systems can continue using their own local data models, interfaces, and terminology systems, while structural interoperability and Semantic Interoperability are handled through rule-based reasoning on formal representations of different models and terminology systems maintained in the SALUS Semantic Resource Set. SALUS Common Information Model at the core of this set acts as the common mediator. We demonstrate the capabilities of our framework through one of the SALUS safety analysis tools, namely, the Case Series Characterization Tool, which have been deployed on top of regional EHR Data Warehouse of the Lombardy Region containing about 1 billion records from 16 million patients and validated by several pharmacovigilance researchers with real-life cases. The results confirm significant improvements in signal detection and evaluation compared to traditional methods with the missing background information.
Full Text Available Abstract Background Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20–39 years using linked data from two national databases in Japan. Methods Two databases of the National Nutrition Survey (NNS and the Survey of Dental Diseases (SDD, which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E. Results Smoking rates differed greatly in men (53.3% and women (15.5%. The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women. Tooth loss occurred more frequently among current smokers (40.6% than former (23.1% and non-smokers (27.9%. Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40–3.50], P = 0.0007 and women (1.70 [1.13–2.55], P = 0.0111. A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend Conclusion An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to
Lee, Wei Wei; Alkureishi, Maria A; Ukabiala, Obioma; Venable, Laura Ruth; Ngooi, Samantha S; Staisiunas, Daina D; Wroblewski, Kristen E; Arora, Vineet M
While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. This was a prospective mixed-methods study. Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive
Full Text Available Overheating is constantly mentioned as a risk factor for bone necrosis that could compromise the dental implant primary stability. Uncontrolled thermal injury can result in a fibrous tissue, interpositioned at the implant-bone interface, compromising the long-term prognosis. The methods used to record temperature rise include either direct recording by thermocouple instruments or indirect estimating by infrared thermography. This preliminary study was carried out using bovine bone and a different method of temperatures rising estimation is presented. Two different types of drills were tested using fluoroptic thermometer and the effectiveness of this alternative temperature recording method was evaluated.
McGovern, Andrew Peter; Woodman, Jenny; Allister, Janice; van Vlymen, Jeremy; Liyanage, Harshana; Jones, Simon; Rafi, Imran; de Lusignan, Simon; Gilbert, Ruth
Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records. Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording. Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern. We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation. This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns
Asimopolos, Laurentiu; Asimopolos, Natalia-Silvia; Sandulescu, Agata Monica; Niculici, Eugen
This paper presents statistical and spectral analysis of data from Surlari Geomagnetic Observatory that contributing to study of geomagnetic variations. Thus were highlighted, for long series of records over several solar cycles, periodicities of 22 years and 11 years. Following the same procedures for medium recording series (multi-annual) have highlighted annual, seasonal and monthly periodicities. For shorter data series, we highlighted diurnal, semidiurnal, 8 hours and even lower periodicities. For very short series with a high sample rate and for few magnetotellurics records, we highlight different types of pulsations (Pc2 - Pc5 and Pi 2). Geomagnetic signals are the convolution product of the atomic stationary signals mono-frequential of different amplitudes associated to phenomena with a very broad band of periodicities and nondeterministic signals associated with geomagnetic disturbances and non-periodic phenomena. Among analysis processes used for discrete series of geomagnetic data with different lengths and sampling rates, can conclude the following: Moving average works as a low pass filter in frequency or high pass in time. By eliminating high frequency components (depending on mobile window size used) can be studied preferential periodicities greater than a given value. Signal linearization (using least squares) provides information on linear trend of the entire series analyzed. Thus, for the very long data series (several decades) we extracted the secular variation slope for each geomagnetic component, separately. The numeric derivative of signal versus time proved to be a very reliable indicator for geomagnetic disturbed periods. Thus, the derivative value may be increased by several orders of magnitude during periods of agitation in comparisons to calm periods. The correlation factor shows significant increases when between two time series a causal relationship exists. Variation of the correlation factor, calculated for a mobile window containing k
Tasa, Umut Burcu; Ozcan, Oguzhan; Yantac, Asim Evren; Unluer, Ayca
It is a known fact that there is a conflict between what users expect and what user interface designers create in the field of medical informatics along with other fields of interface design. The objective of the study is to suggest, from the 'design art' perspective, a method for improving the usability of an electronic medical record (EMR) interface. The suggestion is based on the hypothesis that the user interface of an EMR should be iconographic. The proposed three-step method consists of a questionnaire survey on how hospital users perceive concepts/terms that are going to be used in the EMR user interface. Then icons associated with the terms are designed by a designer, following a guideline which is prepared according to the results of the first questionnaire. Finally the icons are asked back to the target group for proof. A case study was conducted with 64 medical staff and 30 professional designers for the first questionnaire, and with 30 medical staff for the second. In the second questionnaire 7.53 icons out of 10 were matched correctly with a standard deviation of 0.98. Also, all icons except three were matched correctly in at least 83.3% of the forms. The proposed new method differs from the majority of previous studies which are based on user requirements by leaning on user experiments instead. The study demonstrated that the user interface of EMRs should be designed according to a guideline that results from a survey on users' experiences on metaphoric perception of the terms.
van Velthoven, Michelle Helena; Mastellos, Nikolaos; Majeed, Azeem; O'Donoghue, John; Car, Josip
Electronic medical records (EMR) offer a major potential for secondary use of data for research which can improve the safety, quality and efficiency of healthcare. They also enable the measurement of disease burden at the population level. However, the extent to which this is feasible in different countries is not well known. This study aimed to: 1) assess information governance procedures for extracting data from EMR in 16 countries; and 2) explore the extent of EMR adoption and the quality and consistency of EMR data in 7 countries, using management of diabetes type 2 patients as an exemplar. We included 16 countries from Australia, Asia, the Middle East, and Europe to the Americas. We undertook a multi-method approach including both an online literature review and structured interviews with 59 stakeholders, including 25 physicians, 23 academics, 7 EMR providers, and 4 information commissioners. Data were analysed and synthesised thematically considering the most relevant issues. We found that procedures for information governance, levels of adoption and data quality varied across the countries studied. The required time and ease of obtaining approval also varies widely. While some countries seem ready for secondary uses of data from EMR, in other countries several barriers were found, including limited experience with using EMR data for research, lack of standard policies and procedures, bureaucracy, confidentiality, data security concerns, technical issues and costs. This is the first international comparative study to shed light on the feasibility of extracting EMR data across a number of countries. The study will inform future discussions and development of policies that aim to accelerate the adoption of EMR systems in high and middle income countries and seize the rich potential for secondary use of data arising from the use of EMR solutions.
Karusisi, Noëlla; Thomas, Frédérique; Méline, Julie; Chaix, Basile
Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables. Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Four categories of sports were studied: team sports, racket sports, swimming and related activities, and fitness. Spatial accessibility to sport facilities was measured with two complementary approaches that both take into account the street network (distance to the nearest facility and count of facilities around the dwelling). Associations between the spatial accessibility to sport facilities and the practice of the corresponding sports were assessed using multilevel logistic regression after adjusting for individual and contextual characteristics. High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness. Accessibility is a multi-dimensional concept that integrates educational, financial, and geographical aspects. Our work supports the evidence that strategies to increase participation in sport activities should improve the spatial and
Andrew Peter McGovern
Full Text Available Background Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE but there is evidence of substantial under-recording.Aim To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.Method Outcomes were recording of 1 any maltreatment-related codes, 2 child protection proceedings and 3 child was a cause for concern.Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6, child protection procedures (RR 1.4; 95% CI 1.1–1.6 and cause for concern (RR 2.5; 95% CI 1.8–3.4 after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationshipHow this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE, but there is evidence of substantial underrecording. We describe a simple clinical coding
J. J. B. Smith
Full Text Available This paper continues a discussion of approaches and methodologies we have used in our studies of feeding in haematophagous insects. Described are techniques for directly monitoring behaviour: electrical recording of feeding behaviour via resistance changes in the food canal, optical methods for monitoring mouthpart activity, and a computer technique for behavioural event recording. Also described is the use of "flow charts" or "decision diagrams" to model interrelated sequences of behaviours.
The objective of this study is to clarify influence of colleagues in childcare upon the process of understanding a child. Now day, "Episodic Recording Method" is not only childcare recordings but refleective practice in Childcare. The results are as follows. First, there exist both verbal and nonverbal types of information. Second, there are four types of information to modify the teacher's understanding. Third, the information has both quantitative and qualitative effects. The colleagues hav...
Lehnbom, Elin C; McLachlan, Andrew; Brien, Jo-Anne E
A personally controlled electronic health record (PCEHR) system is being implemented in Australia. Every Australian that wants a PCEHR will be able to opt-in from July 2012. To explore the opinions of Australian consumers and healthcare providers about the PCEHR. In this qualitative study, consumers and healthcare providers were interviewed using a semi-structured interview guide. Perceived benefits identified by participants regarding the PCEHR included instant access to clinical information, and safer and more efficient healthcare delivery. The risk of unauthorised access and breaches of privacy were some of the perceived drawbacks. Although consumers seemed unwilling to opt-in to have a PCEHR, the vast majority of healthcare providers were positive towards this development and predicted better and safer healthcare as a result. Consumers and healthcare providers appeared uniformed about the imminent PCEHR. The wide-spread unwillingness among participants to opt-in to have a PCEHR could potentially jeopardise successful implementation and uptake of this system. A well-designed system without security glitches and with individualised information from trusted healthcare providers regarding the benefits of having a PCEHR appears critical in engaging consumer opt-in.
Claverie, Martin; Matthews, Jessica L.; Vermote, Eric F.; Justice, Christopher O.
In- land surface models, which are used to evaluate the role of vegetation in the context ofglobal climate change and variability, LAI and FAPAR play a key role, specifically with respect to thecarbon and water cycles. The AVHRR-based LAIFAPAR dataset offers daily temporal resolution,an improvement over previous products. This climate data record is based on a carefully calibratedand corrected land surface reflectance dataset to provide a high-quality, consistent time-series suitablefor climate studies. It spans from mid-1981 to the present. Further, this operational dataset is availablein near real-time allowing use for monitoring purposes. The algorithm relies on artificial neuralnetworks calibrated using the MODIS LAI/FAPAR dataset. Evaluation based on cross-comparisonwith MODIS products and in situ data show the dataset is consistent and reliable with overalluncertainties of 1.03 and 0.15 for LAI and FAPAR, respectively. However, a clear saturation effect isobserved in the broadleaf forest biomes with high LAI (greater than 4.5) and FAPAR (greater than 0.8) values.
Full Text Available Abstract Background The electronic health record (EHR is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. Methods A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada. At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. Results The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. Conclusions These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition
Méline, Julie; Van Hulst, Andraea; Thomas, Frederique; Chaix, Basile
Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA) traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI): +0.12, +2.60 for 65-80 dB(A) vs 30-45 dB(A)] and DBP [+1.07 (95% CI: +0.28, +1.86)], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP) may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS) tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP.
Full Text Available Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP, diastolic blood pressure (DBP, and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI: +0.12, +2.60 for 65-80 dB(A vs 30-45 dB(A] and DBP [+1.07 (95% CI: +0.28, +1.86], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP.
The results of a study of four successive Early Pliocene geomagnetic reversal records are presented. The polarity transitions have been recorded in the Trubi formation of Calabria (S. Italy). The lower Sidufjall and Lower Nunivak records are nearly identical and have a zonal harmonic content similar to records reported for the Matuyama—Brunhes polarity transition.
Grabenbauer, L; Fraser, R; McClay, J; Woelfl, N; Thompson, C B; Cambell, J; Windle, J
Less than 20% of hospitals in the US have an electronic health record (EHR). In this qualitative study, we examine the perspectives of both academic and private physicians and administrators as stakeholders, and their alignment, to explore their perspectives on the use of technology in the clinical environment. Focus groups were conducted with 74 participants who were asked a series of open-ended questions. Grounded theory was used to analyze the transcribed data and build convergent themes. The relevance and importance of themes was constructed by examining frequency, convergence, and intensity. A model was proposed that represents the interactions between themes. Six major themes emerged, which include the impact of EHR systems on workflow, patient care, communication, research/outcomes/billing, education/learning, and institutional culture. Academic and private physicians were confident of the future benefits of EHR systems, yet cautious about the current implementations of EHR, and its impact on interactions with other members of the healthcare team and with patients, and the amount of time necessary to use EHR's. Private physicians differed on education and were uneasy about the steep learning curve necessary for use of new systems. In contrast to physicians, university and hospital administrators are optimistic, and value the availability of data for use in reporting. The results of our study indicate that both private and academic physicians concur on the need for features that maintain and enhance the relationship with the patient and the healthcare team. Resistance to adoption is related to insufficient functionality and its potential negative impact on patient care. Integration of data collection into clinical workflows must consider the unexpected costs of data acquisition.
Olsen, Jesper; John Anderson, N.; Leng, M.J.
Stable isotope records are increasingly being used in palaeoenvironmental studies of Arctic lakes. Here we compare stable isotope and elemental records (δ13C, δ15N, C/N) with high resolution XRF-derived geochemical and colour data from low Arctic lakes (SS1220 and SS85) in southwest Greenland. Lake...... SS1220 sediments are laminated gyttja whereas SS85 consist of homogeneous gyttja, both records cover the last c. 5000 years. d13C and carbon content suggest that organic matter in both lakes is predominantly autochthonous. The C/N variability, ranging between 11 and 15, is interpreted...... composition of lake sediments when there is a reasonable understanding of limnological processes, and records may be lake specific....
Birkun, Alexei; Glotov, Maksim; Ndjamen, Herman Franklin; Alaiye, Esther; Adeleke, Temidara; Samarin, Sergey
BACKGROUND: To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. METHODS: It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. RESULTS: There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, PCPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.
Schuers, M; Timsit, M; Gillibert, A; Fred, A; Griffon, N; Bénichou, J; Darmoni, S J; Staccini, P
To evaluate the impact of the pharmaceutical patient record use in emergency, geriatric and anaesthesia and intensive care departments, an experimentation was launched in 2013 in 55 hospitals. The purpose of the study was to assess the opinions of physicians and pharmacists about the benefits and usability of the patient pharmaceutical record. An e-mailed self-administered questionnaire was sent to all the pharmacists, anaesthesiologists, geriatricians and emergency physicians of the 55 hospitals involved in the patient pharmaceutical record experimentation. The questionnaire assessed the usability of the patient pharmaceutical record using the "System Usability Scale", as well as its use, its benefits and limitations perceived in clinical practice, and overall user satisfaction. Questionnaires were collected from November 2014 to January 2015. Ninety-six questionnaires were collected, from 47 hospitals, representing 86% of the hospitals involved in the experimentation. The patient pharmaceutical record was effectively operational in 36 hospitals. Data from 73 questionnaires filled by physicians and pharmacists with potential experience with the patient pharmaceutical record were used for evaluation. Forty-two respondents were pharmacists (57%) and 31 were physicians (43%), including 13 geriatricians, 11 emergency physicians and 7 anaesthesiologists. Patient pharmaceutical record overall usability score was 62.5 out of 100. It did not vary with the profession or seniority of the respondent. It was positively correlated with the frequency of use. More than half of respondents reported that they never or uncommonly used the patient pharmaceutical record. The length of access to data period was considered as insufficient. Main obstacles to more utilization of the patient pharmaceutical record were the lack of information about the dosage of dispensed drugs, the low number of patients in possession of their health card and the low number of patients with an activated
Nakagawa, Haruo; Kanda, Keiji
A national radiation dose registration system is proposed in this paper. In Japan, only one radiation dose registration system is partly effective. It is applied for workers in nuclear power plants which are under control of regulatory laws for nuclear reactors. The total system was proposed previously by the Committee for Compensation Claims of Nuclear Accidents. The reason for the delay in establishing a registration system for all radiation workers is supposedly a lack of effort to adjust differences among items in radiation protection laws and the promotion of public acceptance to atomic power. Items about dose recordings, record keeping and dose-record reporting in all of the radiation regulatory laws are compared to each other, and items were extracted for revision. (author)
Full Text Available Abstract Background Coxibs are claimed to be cost-effective drugs and reduced prescription of gastroprotective agents is assumed to be one of their major benefits. Real life prescription of these drugs may be substantially different than that considered in pharmacoeconomic analyses or claimed by drug companies, yet. Our objective was to evaluate whether coxibs were associated with reduced prescription of gastro-protective agents (GPAs, specifically proton pump inhibitors, H2 blockers and misoprostol compared to non selective NSAIDs. Methods A record-linkage study was performed using 2001 outpatient prescription data from the province of Modena (about 632,000 inhabitants, in Northern Italy. Logistic regression was used to calculate the odds ratio of GPA prescription for coxib and non-selective NSAID adult users (> 14 years. Three categories of users were further investigated: "acute", "chronic and "incident or new". Main outcome measures were same-day co-prescription and 30 days prescription of GPAs in coxibs and non selective NSAIDs users. To limit selection bias, data were adjusted for age, sex, DDD of coxibs and non selective NSAIDs received during 2001, DDD of GPAs and (for non-incident users DDD of NSAIDs received during the previous 4 years Results Same day co-prescription rates were similar considering the overall population and "acute" users. Chronic coxibs users instead showed higher co-prescription rates than chronic NSAIDs users (OR = 1.2, p Conclusion Assumptions made in pharmacoeconomic analyses on coxibs (lower GPA prescription associated with coxibs use may be overly optimistic. Claims made through cost-effectiveness data should be carefully interpreted, and mechanisms for attributing drug prices revised accordingly.
Full Text Available Background The symptom of fatigue is one of the top five most frequently presented health complaints in primary care, yet it remains underexplored in the Canadian primary care context.Objective The objective of this study was to examine the prevalence and impact of patients presenting with fatigue in primary care, using the only known electronic database in Canada to capture patient-reported symptoms.Methods Data were extracted from the Deliver Primary Healthcare Information (DELPHI database, an electronic medical record database located in Ontario, Canada. Patients were identified using the International Classification of Primary Care, Revised Second Edition coding system. Two groups of patients (fatigue or non-fatigue symptom were followed for one year and compared. Both descriptive and multivariable analyses were conducted.Results A total of 103 fatigue symptom patients, and 103 non-fatigue symptom patients, were identified in the DELPHI database. The period prevalence of fatigue presentation was 8.2%, with the majority of patients being female and over 60 years of age. These patients experienced numerous co-occurring morbidities, in addition to the fatigue itself. During the one year follow-up period, fatigue symptom patients had significantly higher rates of subsequent visits (IRR = 1.19, p = 0.038 and investigations (IRR = 1.68, p < 0.001, and markedly high levels of referrals following their index visit.Conclusions This research used an electronic database to examine the symptom, fatigue. Using these data, fatigue symptom patients were found to have higher rates of health care utilisation, compared to non-fatigue symptom patients.
Shen, Jay J; Ginn, Gregory O
Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. Financial position does relate to EHR adoption in mid-term and long-term planning.
Rizvi, Rubina F; Marquard, Jenna L; Hultman, Gretchen M; Adam, Terrence J; Harder, Kathleen A; Melton, Genevieve B
Background A substantial gap exists between current Electronic Health Record (EHR) usability and potential optimal usability. One of the fundamental reasons for this discrepancy is poor incorporation of a User-Centered Design (UCD) approach during the Graphical User Interface (GUI) development process. Objective To evaluate usability strengths and weaknesses of two widely implemented EHR GUIs for critical clinical notes usage tasks. Methods Twelve Internal Medicine resident physicians interacting with one of the two EHR systems (System-1 at Location-A and System-2 at Location-B) were observed by two usability evaluators employing an ethnographic approach. User comments and observer findings were analyzed for two critical tasks: (1) clinical notes entry and (2) related information-seeking tasks. Data were analyzed from two standpoints: (1) usability references categorized by usability evaluators as positive, negative, or equivocal and (2) usability impact of each feature measured through a 7-point severity rating scale. Findings were also validated by user responses to a post observation questionnaire. Results For clinical notes entry, System-1 surpassed System-2 with more positive (26% vs. 12%) than negative (12% vs. 34%) usability references. Greatest impact features on EHR usability (severity score pertaining to each feature) for clinical notes entry were: autopopulation (6), screen options (5.5), communication (5), copy pasting (4.5), error prevention (4.5), edit ability (4), and dictation and transcription (3.5). Both systems performed equally well on information-seeking tasks and features with greatest impacts on EHR usability were navigation for notes (7) and others (e.g., looking for ancillary data; 5.5). Ethnographic observations were supported by follow-up questionnaire responses. Conclusion This study provides usability-specific insights to inform future, improved, EHR interface that is better aligned with UCD approach.
Li, Ming; He, Wei
Escape from fear (EFF) is an active response to a conditioned stimulus (CS) previously paired with an unconditioned fearful stimulus (US), which typically leads to the termination of the CS. In this paradigm, animals acquire two distinct associations: S-S [CS-US] and R-O [response-outcome] through Pavlovian and instrumental conditioning, respectively. The present study describes a computer controlled automatic recording system that captures the development of EFF and allows the determination of the respective roles of S-S and R-O associations in this process. We validated this system by showing that only rats subjected to a simultaneous CS-US conditioning (i.e., CS and US occur together at the beginning of each trial) acquired EFF, not those subjected to an unpaired CS-US conditioning. Paired rats had a progressively increased number of EFF and significantly shorter escape latencies than unpaired rats across the 5-trial blocks on the test day. However, during the conditioning phase, the unpaired rats emitted more 22kHz ultrasonic vocalizations, a validated measure of conditioned reactive fear responses. Our results demonstrate that the acquisition of EFF is contingent upon pairing of the CS with the US, not simply the consequence of a high level of generalized fear. Because this commercially available system is capable of examining both conditioned active and reactive fear responses in a single setup, it could be used to determine the relative roles of S-S and R-O associations in EFF, the neurobiology of conditioned active fear response and neuropharmacology of psychotherapeutic drugs. Copyright © 2013 Elsevier B.V. All rights reserved.
Yoo, Sooyoung; Kim, Seok; Lee, Seungja; Lee, Kee-Hyuck; Baek, Rong-Min; Hwang, Hee
Although the adoption rates for Electronic Health Records (EHRs) are growing, significant opportunities for further advances in EHR system design remain. The goal of this study was to identify issues that should be considered in the design process for the successful development of future systems by analyzing end users' service requests gathered during a recent three-year period after a comprehensive EHR system was implemented at Seoul National University's Bundang Hospital in South Korea. Data on 11,400 service requests from end users of the EHR system made from 2008 through 2010 were used in this study. The requests were categorized as program modification/development, data request, insurance-fee identification/generation, patient-record merging, or other. The authors further subcategorized the requests for program modification/development into the following nine areas of concern: (1) indicators and statistics, (2) patient safety and quality of care, (3) special task-oriented functionalities, (4) ease of use and user interface, (5) system speed, (6) interoperability and integration, (7) privacy and security, (8) customer service, and (9) miscellaneous. The system users were divided into four groups--direct care, care support, administrative/insurance, and general management--to identify each group's needs and concerns. The service requests for program modification/development, data request, insurance-fee identification/generation, patient-record merging, and other issues constituted approximately 49.2%, 33.9%, 11.4%, 4.0%, and 1.5% of the total data set, respectively. The number of data-request service requests grew over the three years studied. Different groups of users were found to have different concerns according to their activities and tasks. Within the program-modification/development category, end users were most frequently concerned with ease of use and user interface (38.1% of the total) and special task-oriented functionalities (29.3% of the total) in
Zheng, Jiaping; Yu, Hong
Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients' comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople's perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas' appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople's perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. The distributions of both readability formulas' scores (Preadability predictions and laypeople's perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (Preadability formulas' predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were
Schneider, Hanna; Hill, Susan
Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control
Full Text Available Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female. The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%. The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046, intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047, referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001, and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001 were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035. Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from
Full Text Available The feasibility of using imperfectly phenotyped "silver standard" samples identified from electronic medical record diagnoses is considered in genetic association studies when these samples might be combined with an existing set of samples phenotyped with a gold standard technique. An analytic expression is derived for the power of a chi-square test of independence using either research-quality case/control samples alone, or augmented with silver standard data. The subset of the parameter space where inclusion of silver standard samples increases statistical power is identified. A case study of dementia subjects identified from electronic medical records from the Electronic Medical Records and Genomics (eMERGE network, combined with subjects from two studies specifically targeting dementia, verifies these results.
Le Heuzey, Jean-Yves; Breithardt, Günter; Camm, John
The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation (RecordAF) is the first worldwide, 1-year observational, longitudinal study of the management of paroxysmal/persistent atrial fibrillation (AF) in recently diagnosed patients. The study was conducted at 532 sites...
Adeyemi, Oluwakemi A.
The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…
May, Joy L.
The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…
Background: Electronic health records (EHRs) are a ubiquitous component of the United States healthcare system and capture nearly all data collected in a clinic or hospital setting. EHR databases are attractive for secondary data analysis as they may contain detailed clinical rec...
The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers' perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned…
Blijleven, Vincent; Koelemeijer, Kitty; Jaspers, Monique
Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow that are unintentionally imposed by electronic health record (EHR) systems. Although workarounds may seem favorable at first sight, they are generally suboptimal and may
... attended; and scores on reading and mathematics achievement tests. The system of records also includes... congressionally mandated national assessment of Individuals with Disability Education Act (IDEA). It will be... characteristics? Compare Current Transition-Age Students With an IEP to Their Peers in Prior Cohorts How do the...
Wang, Can; Bin, Chen; Christman, Lilianna E.; Glen, Jonathan M. G.; Klemperer, Simon L.; McPhee, Darcy K.; Kappler, Karl N.; Bleier, Tom E.; Dunson, J. Clark
When working with ultra-low-frequency (ULF) magnetic datasets, as with most geophysical time-series data, it is important to be able to distinguish between cultural signals, internal instrument noise, and natural external signals with their induced telluric fields. This distinction is commonly attempted using simultaneously recorded data from a spatially remote reference site. Here, instead, we compared data recorded by two systems with different instrumental characteristics at the same location over the same time period. We collocated two independent ULF magnetic systems, one from the QuakeFinder network and the other from the United States Geological Survey (USGS)-Stanford network, in order to cross-compare their data, characterize data reproducibility, and characterize signal origin. In addition, we used simultaneous measurements at a remote geomagnetic observatory to distinguish global atmospheric signals from local cultural signals. We demonstrated that the QuakeFinder and USGS-Stanford systems have excellent coherence, despite their different sensors and digitizers. Rare instances of isolated signals recorded by only one system or only one sensor indicate that caution is needed when attributing specific recorded signal features to specific origins.[Figure not available: see fulltext.
Ghosh, A.K.; Rao, K.S.
Fourier spectra of 54 earthquake accelerograms recorded on rock sites in the U.S.A. have been analysed. These could be used in generation of synthetic accelerogramms for seismic design. (author). 19 figs., 1 tab., 1 appendix, 19 re fs
S. de Bie (Sandra); P.M. Coloma (Preciosa); C. Ferrajolo (Carmen); K.M.C. Verhamme (Katia); G. Trifirò (Gianluca); M.J. Schuemie (Martijn); S.M.J.M. Straus (Sabine); R. Gini (Rosa); R.M.C. Herings (Ron); G. Mazzaglia (Giampiero); G. Picelli (Gino); A. Ghirardi (Arianna); L. Pedersen (Lars); B.H.Ch. Stricker (Bruno); J. van der Lei (Johan); M.C.J.M. Sturkenboom (Miriam)
textabstractAim Electronic healthcare record (EHR)-based surveillance systems are increasingly being developed to support early detection of safety signals. It is unknown what the power of such a system is for surveillance among children and adolescents. In this paper we provide estimates of the
Burgher, Karl E.; Snyder, Michael
This is the third in a series of eight articles on project management (PM) in the academy. In this article, the authors describe the step-by-step implementation of a structural change to Indiana State University's (ISU's) Office of Registration and Records (ORR). The process described may vary as it is implemented elsewhere, but the authors…
Akhoun, Idrick; Moulin, Annie; Jeanvoine, Arnaud; Ménard, Mikael; Buret, François; Vollaire, Christian; Scorretti, Riccardo; Veuillet, Evelyne; Berger-Vachon, Christian; Collet, Lionel; Thai-Van, Hung
Speech elicited auditory brainstem responses (Speech ABR) have been shown to be an objective measurement of speech processing in the brainstem. Given the simultaneous stimulation and recording, and the similarities between the recording and the speech stimulus envelope, there is a great risk of artefactual recordings. This study sought to systematically investigate the source of artefactual contamination in Speech ABR response. In a first part, we measured the sound level thresholds over which artefactual responses were obtained, for different types of transducers and experimental setup parameters. A watermelon model was used to model the human head susceptibility to electromagnetic artefact. It was found that impedances between the electrodes had a great effect on electromagnetic susceptibility and that the most prominent artefact is due to the transducer's electromagnetic leakage. The only artefact-free condition was obtained with insert-earphones shielded in a Faraday cage linked to common ground. In a second part of the study, using the previously defined artefact-free condition, we recorded speech ABR in unilateral deaf subjects and bilateral normal hearing subjects. In an additional control condition, Speech ABR was recorded with the insert-earphones used to deliver the stimulation, unplugged from the ears, so that the subjects did not perceive the stimulus. No responses were obtained from the deaf ear of unilaterally hearing impaired subjects, nor in the insert-out-of-the-ear condition in all the subjects, showing that Speech ABR reflects the functioning of the auditory pathways.
Full Text Available The term record group means a group of fonds (records and it is a type of archival fonds rarely described in Polish archival literature. Most often it is associated with the complex archival fonds, due to its comlicated structure and blurred borderlines – an effect of administrative system varying from the Polish one. The post-war attempts to modify and broaden the meaning of the complex fonds caused its resemblance to the term record group. Irena Radtke in her paper given during the 6th Archival Methods Conference in Warsaw in 1970 proposed, that the complex fonds should be one comprising records of foreign provenance that are an effect of passive succession. Bohdan Ryszewski, addressing Radtke’s idea, noticed that passive succession might be a source of complications. However, this conceptualization of the definition of the complex fonds did not correspond with the American understanding of it as an above-fonds structure.Bogdan Kroll has touched the core of the problem; he noticed that an archival construction comprising materials of various provenances cannot be seen neither as an archival fonds, nor as a complex fonds. He saw a discrepancy between the structure and partition of archival holdings and archival theory; thus Kroll proposed abandoning the term complex fonds and implementation of the term archival complex. The archival complex was supposed to be archival materials of various origins merged (in or outside of an archive into fonds, or parts of archival fonds of different institutions having the same characteristic – function. The complex was supposed to make up a separate entity in logic structure of archival holdings, comprising of all archival fonds and/or their pieces being parts of the main fonds of the complex. The problem of lack of above-fonds forms in the Polish archival theory has been also noticed by Józef Siemieński, who has formulated the term of higher-order fonds. According to his idea the higher
Alsaffar, Mona; Yellowlees, Peter; Odor, Alberto; Hogarth, Michael
Electronic health records (EHR) are a key tool in managing and storing patients' information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers' motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were "certified" EHRs. Health care F/OSS developers were also surveyed using an online survey. At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been
Katzenellenbogen Judy M
Full Text Available Abstract Background Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease. Methods Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive and stratified by region, age and gender. The index admission was the baseline comparator. Results Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9% persons identified as Aboriginal on index admission. An additional 83 (2.7% Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50% of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%. Conclusions Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian
Epstein, Barbara A; Tannery, Nancy H; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B
What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? The development took place at the University of Pittsburgh Health Sciences Library System. The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized "on the fly" into meaningful categories using clustering technology and are directly accessible from the results page. After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.
Hendra, Yuli; Fauzi, Manyuk; Sutikno, Sigit
The availability of data on hydrological modeling always become a problem considering the incompleteness and the imprecision of data. As the development of technology, many models of hidrology using data acquired from the satellite have emerged. The accuracy and the model correlation was still unachieved from the previous research using satellite data. This problems was caused by the unstable weather conditions thus the process of recording and dowloading of the satellite data become less opt...
Sales, Allan; Balby, Leandro; Cajueiro, Adalberto
Students’ dropout is a major concern of the Brazilian higher education institutions as it may cause waste of resources and decrease graduation rates. The early detection of students with high probability of dropping out, as well as understanding the underlying causes, are crucial for defining more effective actions toward preventing this problem. In this paper, we cast the dropout detection problem as a classification problem. We use a large sample of academic records of students across 76 co...
Mammola, Stefano; Michalik, Peter; Hebets, Eileen A; Isaia, Marco
Organismal biology has been steadily losing fashion in both formal education and scientific research. Simultaneous with this is an observable decrease in the connection between humans, their environment, and the organisms with which they share the planet. Nonetheless, we propose that organismal biology can facilitate scientific observation, discovery, research, and engagement, especially when the organisms of focus are ubiquitous and charismatic animals such as spiders. Despite being often feared, spiders are mysterious and intriguing, offering a useful foundation for the effective teaching and learning of scientific concepts and processes. In order to provide an entryway for teachers and students-as well as scientists themselves-into the biology of spiders, we compiled a list of 99 record breaking achievements by spiders (the "Spider World Records"). We chose a world-record style format, as this is known to be an effective way to intrigue readers of all ages. We highlighted, for example, the largest and smallest spiders, the largest prey eaten, the fastest runners, the highest fliers, the species with the longest sperm, the most venomous species, and many more. We hope that our compilation will inspire science educators to embrace the biology of spiders as a resource that engages students in science learning. By making these achievements accessible to non-arachnologists and arachnologists alike, we suggest that they could be used: (i) by educators to draw in students for science education, (ii) to highlight gaps in current organismal knowledge, and (iii) to suggest novel avenues for future research efforts. Our contribution is not meant to be comprehensive, but aims to raise public awareness on spiders, while also providing an initial database of their record breaking achievements.
Al Shammary N
Full Text Available Nawaf Al Shammary,1 Koula Asimakopoulou,1 Fraser McDonald,2 Jonathon T Newton,1 Sasha Scambler1 1Division of Population and Patient Health, 2Craniofacial Development and Stem Cell Biology Department, King’s College London Dental Institute, London, UKBackground: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS London hospital.Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87 provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.Results: The term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1 the clinical aspects of treatment, 2 clinician–patient interaction factors and 3 patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.Conclusion: Adherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency. Keywords: adherence, adults, orthodontic treatment
Full Text Available Abstract Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397 who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.
Pizza, Fabio; Antelmi, Elena; Vandi, Stefano; Meletti, Stefano; Erro, Roberto; Baumann, Christian R; Bhatia, Kailash P; Dauvilliers, Yves; Edwards, Mark J; Iranzo, Alex; Overeem, Sebastiaan; Tinazzi, Michele; Liguori, Rocco; Plazzi, Giuseppe
To describe the motor pattern of cataplexy and to determine its phenomenological differences from pseudocataplexy in the differential diagnosis of episodic falls. We selected 30 video-recorded cataplexy and 21 pseudocataplexy attacks in 17 and 10 patients evaluated for suspected narcolepsy and with final diagnosis of narcolepsy type 1 and conversion disorder, respectively, together with self-reported attacks features, and asked expert neurologists to blindly evaluate the motor features of the attacks. Video documented and self-reported attack features of cataplexy and pseudocataplexy were contrasted. Video-recorded cataplexy can be positively differentiated from pseudocataplexy by the occurrence of facial hypotonia (ptosis, mouth opening, tongue protrusion) intermingled by jerks and grimaces abruptly interrupting laughter behavior (i.e. smile, facial expression) and postural control (head drops, trunk fall) under clear emotional trigger. Facial involvement is present in both partial and generalized cataplexy. Conversely, generalized pseudocataplexy is associated with persistence of deep tendon reflexes during the attack. Self-reported features confirmed the important role of positive emotions (laughter, telling a joke) in triggering the attacks, as well as the more frequent occurrence of partial body involvement in cataplexy compared with pseudocataplexy. Cataplexy is characterized by abrupt facial involvement during laughter behavior. Video recording of suspected cataplexy attacks allows the identification of positive clinical signs useful for diagnosis and, possibly in the future, for severity assessment.
Savenije, B; Lambooij, E; Pieterse, C; Korf, J
Electrical stunning in the process of slaughtering poultry is used to induce unconsciousness and immobilize the animal for easier processing. Unconsciousness is a function of brain damage. Brain damage has been studied with brain impedance recordings under ischemic conditions. This experiment
Data-driven analytic methods are a valuable aid to signal detection of ADEs from large electronic health records for drug safety monitoring. This study finds the methods can detect known ADE and so could potentially be used to detect unknown ADE.
Sollie, Annet; Sijmons, Rolf H.; Helsper, Charles W.; Numans, Mattijs E.
Objectives: To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. Methods: A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs)
Rauscher, Kimberly J; Runyan, Carol W; Radisch, Deborah
Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that
McInnes, E F; Scudamore, C L
Pathological evaluation of lesions caused directly by xenobiotic treatment must always take into account the recognition of background (incidental) findings. Background lesions can be congenital or hereditary, histological variations, changes related to trauma or normal aging and physiologic or hormonal changes. This review focuses on the importance and correct approach to recording of background changes and includes discussion on sources of variability in background changes, the correct use of terminology, the concept of thresholds, historical control data, diagnostic drift, blind reading of slides, scoring and artifacts. The review is illustrated with background lesions in Sprague Dawley and Wistar rats. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
The book discusses the theoretical path to decoding the information gathered from observations of old stellar systems. It focuses on old stellar systems because these are the fossil record of galaxy formation and provide invaluable information ont he evolution of cosmic structures and the universe as a whole. The aim is to present results obtained in the past few years for theoretical developments in low mass star research and in advances in our knowledge of the evolution of old stellar systems. A particularly representative case is the recent discovery of multiple stellar populations in galac
Through the combination of manual retrieval and computerized retrieval, medical records of acupuncture-moxibustion in The Twenty-Four Histories were collected. Acupuncture cases from the Spring and Autumn Period (770-476 B.C.) to the end of the Ming Dynasty (1368-1644)were retrieved. From the medical records of acupuncture-moxibustion in Chinese official history books, it can be found that systematic diseases or emergent and severe diseases were already treated by physicians with the combination of acupuncture and medicine as early as in the Spring and Autumn Period as well as the Warring States Period(475-221 B.C.). CANG Gong, a famous physician of the Western Han Dynasty (206 B. C.-A. D. 24), cured diseases by selecting points along the running courses of meridians where the illness inhabited, which indicates that the theory of meridians and collaterals was served as a guide for clinical practice as early as in the Western Han Dynasty. Blood letting therapy, which has surprising effect, was often adopted by physicians of various historical periods to treat diseases. And treatment of diseases with single point was approved to be easy and effective.
Full Text Available To study the involvement of the anterior nuclei of the thalamus (ANT as compared to the involvement of the hippocampus in the processes of encoding and recognition during visual and verbal memory tasks.We studied intracerebral recordings in patients with pharmacoresistent epilepsy who underwent deep brain stimulation (DBS of the ANT with depth electrodes implanted bilaterally in the ANT and compared the results with epilepsy surgery candidates with depth electrodes implanted bilaterally in the hippocampus. We recorded the event-related potentials (ERPs elicited by the visual and verbal memory encoding and recognition tasks.P300-like potentials were recorded in the hippocampus by visual and verbal memory encoding and recognition tasks and in the ANT by the visual encoding and visual and verbal recognition tasks. No significant ERPs were recorded during the verbal encoding task in the ANT. In the visual and verbal recognition tasks, the P300-like potentials in the ANT preceded the P300-like potentials in the hippocampus.The ANT is a structure in the memory pathway that processes memory information before the hippocampus. We suggest that the ANT has a specific role in memory processes, especially memory recognition, and that memory disturbance should be considered in patients with ANT-DBS and in patients with ANT lesions. ANT is well positioned to serve as a subcortical gate for memory processing in cortical structures.
Štillová, Klára; Jurák, Pavel; Chládek, Jan; Chrastina, Jan; Halámek, Josef; Bočková, Martina; Goldemundová, Sabina; Říha, Ivo; Rektor, Ivan
To study the involvement of the anterior nuclei of the thalamus (ANT) as compared to the involvement of the hippocampus in the processes of encoding and recognition during visual and verbal memory tasks. We studied intracerebral recordings in patients with pharmacoresistent epilepsy who underwent deep brain stimulation (DBS) of the ANT with depth electrodes implanted bilaterally in the ANT and compared the results with epilepsy surgery candidates with depth electrodes implanted bilaterally in the hippocampus. We recorded the event-related potentials (ERPs) elicited by the visual and verbal memory encoding and recognition tasks. P300-like potentials were recorded in the hippocampus by visual and verbal memory encoding and recognition tasks and in the ANT by the visual encoding and visual and verbal recognition tasks. No significant ERPs were recorded during the verbal encoding task in the ANT. In the visual and verbal recognition tasks, the P300-like potentials in the ANT preceded the P300-like potentials in the hippocampus. The ANT is a structure in the memory pathway that processes memory information before the hippocampus. We suggest that the ANT has a specific role in memory processes, especially memory recognition, and that memory disturbance should be considered in patients with ANT-DBS and in patients with ANT lesions. ANT is well positioned to serve as a subcortical gate for memory processing in cortical structures.
Stillová, K; Jurák, P; Chládek, J; Halámek, J; Telecká, S; Rektor, I
The objective is to study the involvement of the posterior medial cortex (PMC) in encoding and retrieval by visual and auditory memory processing. Intracerebral recordings were studied in two epilepsy-surgery candidates with depth electrodes implanted in the retrosplenial cingulate, precuneus, cuneus, lingual gyrus and hippocampus. We recorded the event-related potentials (ERP) evoked by visual and auditory memory encoding-retrieval tasks. In the hippocampus, ERP were elicited in the encoding and retrieval phases in the two modalities. In the PMC, ERP were recorded in both the encoding and the retrieval visual tasks; in the auditory modality, they were recorded in the retrieval task, but not in the encoding task. In conclusion, the PMC is modality dependent in memory processing. ERP is elicited by memory retrieval, but it is not elicited by auditory encoding memory processing in the PMC. The PMC appears to be involved not only in higher-order top-down cognitive activities but also in more basic, rather than bottom-up activities.
Kerr, Zachary; Evenson, Kelly R; Moore, Kari; Block, Richard; Diez Roux, Ana V
To explore the association of changes in perceived safety and police-recorded crime with changes in transport and leisure walking using longitudinal data from Chicago residents participating in the Multi-Ethnic Study of Atherosclerosis (2000-2012). Main exposures included perceived safety (self-reported as feeling safe walking in the neighborhood and reporting violence to be a problem in the neighborhood), and one-year counts of police-recorded crime occurring within a one-mile buffer of participants' residences. Main outcomes included transport and leisure walking (self-reported and calculated as total minutes/week across four study visits). Fixed effects models assessed the association of change in perceived safety and police-recorded crime with changes in transport and leisure walking over a 10-year period for 796 adults. No associations were found between changes in perceived safety and either changes in transport or leisure walking. Residing in areas with increases in murder was associated with decreases in transport walking. However, no other associations were found with police-recorded crime. There continues to be a need to explore the benefits of cultivating safe neighborhoods that enhance resident health and well-being. Research should continue examining how community initiatives may build safe environments and community identity that promote walking. Copyright © 2015 Elsevier Inc. All rights reserved.
Maria U. Kottwitz; Volker Schade; Christian Burger; Lorenz Radlinger; Achim Elfering
Background: Although work absenteeism is in the focus of occupational health, longitudinal studies on organizational absenteeism records in hospital work are lacking. This longitudinal study tests time pressure and lack of time autonomy to be related to higher sickness absenteeism. Methods: Data was collected for 180 employees (45% nurses) of a Swiss hospital at baseline and at follow-up after 1 year. Absent times (hours per month) were received from the human resources department of the hosp...
Yu, Ning; Donnan, Peter T; Leese, Graham P
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, but the majority of cases are perceived to be mild and remain untreated. To determine the risk of mortality and morbidities in patients with mild PHPT. Tayside, Scotland, 1997-2006. A historical, prospective, record-linkage, population-based, matched cohort study. All patients with diagnosed but untreated, mild PHPT. METHOD AND OUTCOME MEASURES: Each patient with PHPT was matched with five population-based comparators, by age, gender and calendar year of PHPT diagnosis, selected from the general population. Primary outcomes were all-cause mortality, fatal and nonfatal cardiovascular disease (CVD). Secondary outcomes were cancer-related deaths and other hospital admitted morbidities, including cerebrovascular disease, fractures, hypertension, psychiatric disease, renal complications, cancer and diabetes. The risk was assessed using the Cox proportional hazards model, adjusting for confounding factors of pre-existing co-morbidities, previous prescription of bisphosphonates, socio-economic deprivation score and the probability of having a calcium check. Compared to the matched cohort, the risk of all cause mortality, fatal and nonfatal CVD was increased in patients with asymptomatic PHPT: adjusted hazard ratios (HR) 1·64 (95% CI: 1·43-1·87), 1·64 (95% CI: 1·32-2·04) and 2·48 (95% CI: 2·13-2·89), respectively. The risk was also increased in all secondary outcomes, with the risk of renal failure and renal stones being the highest, adjusted HRs being 13·83 (95% CI: 10·41-18·37) and 5·15 (95% CI: 2·69-9·83), respectively. Patients with mild PHPT had an increased risk of mortality, fatal and nonfatal CVD, and the risk of developing other co-morbidities was also increased. © 2011 Blackwell Publishing Ltd.
Brian K Lee
Full Text Available BACKGROUND: Although screening for maternal red blood cell antibodies during pregnancy is a standard procedure, the prevalence and clinical consequences of non-anti-D immunization are poorly understood. The objective was to create a national database of maternal antibody screening results that can be linked with population health registers to create a research resource for investigating these issues. STUDY DESIGN AND METHODS: Each birth in the Swedish Medical Birth Register was uniquely identified and linked to the text stored in routine maternal antibody screening records in the time window from 9 months prior to 2 weeks after the delivery date. These text records were subjected to a computerized search for specific antibodies using regular expressions. To illustrate the research potential of the resulting database, selected antibody prevalence rates are presented as tables and figures, and the complete data (from more than 60 specific antibodies presented as online moving graphical displays. RESULTS: More than one million (1,191,761 births with valid screening information from 1982-2002 constitute the study population. Computerized coverage of screening increased steadily over time and varied by region as electronic records were adopted. To ensure data quality, we restricted analysis to birth records in areas and years with a sustained coverage of at least 80%, representing 920,903 births from 572,626 mothers in 17 of the 24 counties in Sweden. During the study period, non-anti-D and anti-D antibodies occurred in 76.8/10,000 and 14.1/10,000 pregnancies respectively, with marked differences between specific antibodies over time. CONCLUSION: This work demonstrates the feasibility of creating a nationally representative research database from the routine maternal antibody screening records from an extended calendar period. By linkage with population registers of maternal and child health, such data are a valuable resource for addressing important
Parker Gaddis, K L; Megonigal, J H; Clay, J S; Wolfe, C W
Ketosis is one of the most frequently reported metabolic health events in dairy herds. Several genetic analyses of ketosis in dairy cattle have been conducted; however, few have focused specifically on Jersey cattle. The objectives of this research included estimating variance components for susceptibility to ketosis and identification of genomic regions associated with ketosis in Jersey cattle. Voluntary producer-recorded health event data related to ketosis were available from Dairy Records Management Systems (Raleigh, NC). Standardization was implemented to account for the various acronyms used by producers to designate an incidence of ketosis. Events were restricted to the first reported incidence within 60 d after calving in first through fifth parities. After editing, there were a total of 42,233 records from 23,865 cows. A total of 1,750 genotyped animals were used for genomic analyses using 60,671 markers. Because of the binary nature of the trait, a threshold animal model was fitted using THRGIBBS1F90 (version 2.110) using only pedigree information, and genomic information was incorporated using a single-step genomic BLUP approach. Individual single nucleotide polymorphism (SNP) effects and the proportion of variance explained by 10-SNP windows were calculated using postGSf90 (version 1.38). Heritability of susceptibility to ketosis was 0.083 [standard deviation (SD) = 0.021] and 0.078 (SD = 0.018) in pedigree-based and genomic analyses, respectively. The marker with the largest associated effect was located on chromosome 10 at 66.3 Mbp. The 10-SNP window explaining the largest proportion of variance (0.70%) was located on chromosome 6 beginning at 56.1 Mbp. Gene Ontology (GO) and Medical Subject Heading (MeSH) enrichment analyses identified several overrepresented processes and terms related to immune function. Our results indicate that there is a genetic component related to ketosis susceptibility in Jersey cattle and, as such, genetic selection for
Roshanov Pavel S
Full Text Available Abstract Background Physicians practicing in ambulatory care are adopting electronic health record (EHR systems. Governments promote this adoption with financial incentives, some hinged on improvements in care. These systems can improve care but most demonstrations of successful systems come from a few highly computerized academic environments. Those findings may not be generalizable to typical ambulatory settings, where evidence of success is largely anecdotal, with little or no use of rigorous methods. The purpose of our pilot study was to evaluate the impact of a diabetes specific chronic disease management system (CDMS on recording of information pertinent to guideline-concordant diabetes care and to plan for larger, more conclusive studies. Methods Using a before–after study design we analyzed the medical record of approximately 10 patients from each of 3 diabetes specialists (total = 31 who were seen both before and after the implementation of a CDMS. We used a checklist of key clinical data to compare the completeness of information recorded in the CDMS record to both the clinical note sent to the primary care physician based on that same encounter and the clinical note sent to the primary care physician based on the visit that occurred prior to the implementation of the CDMS, accounting for provider effects with Generalized Estimating Equations. Results The CDMS record outperformed by a substantial margin dictated notes created for the same encounter. Only 10.1% (95% CI, 7.7% to 12.3% of the clinically important data were missing from the CDMS chart compared to 25.8% (95% CI, 20.5% to 31.1% from the clinical note prepared at the time (p p Conclusions The CDMS chart captured information important for the management of diabetes more often than dictated notes created with or without its use but we were unable to detect a difference in completeness between notes dictated in CDMS-associated and usual-care encounters. Our sample of
The results of a study of four successive Early Pliocene geomagnetic reversal records are presented. The polarity transitions have been recorded in the Trubi formation of Calabria (S. Italy). The lower Sidufjall and Lower Nunivak records are nearly identical and have a zonal harmonic content
Yu, Ping; Qian, Siyu; Yu, Hui; Lei, Jianbo
Measuring the performance of electronic health records (EHR) is an important, yet un-resolved challenge. Various measurements have addressed different aspects of EHR success, yet a holistic, comprehensive measurement tool needs to be developed to capture the potential EHR success variables completely. A self-administered questionnaire survey instrument was developed based on the theoretical framework of the DeLone and McLean Information Systems Success Model. It measures nigh variables of EHR success: system quality, information quality, service quality, training, self efficacy, intention to use, use, user satisfaction and net benefits. The instrument was used to measure the performance of aged care EHR systems in three aged care organizations. The results suggest that the instrument was reliable.
A new integrated magnetic head is described. The head was made by vacuum deposition using a mask. A magnetically coupled multilayer construction led to high performance. The results obtained indicate that the device functions equally well, for reading and writing. A set of calculations was developed which could simulate and optimize the behavior of the recording head. The results obtained with the writing were in good agreement with those obtained from experiments and quite different from results which have been several times previously published. In addition a new method was developed for measuring high fields in confined spaces; a 1000 A diameter probe was used in conjunction with a low angle diffraction procedure. The measurements give results which are very different from those obtained by current theories based on the magnetic potentials at the surface. (author) [fr
Moch Fikriansyah Wicaksono
Full Text Available Record creation and management by individuals or organizations grows rapidly, particularly the change from print to electronics, and the smallest part of record (metadata. Therefore, there is a need to perform record management metadata, particularly for students who have the needs of recording references and citation. Reference management software (RMS is a software to help reference management, one of them named zotero. The purpose of this article is to describe the benefits of record management for the writing of scientific papers for students, especially on biology study program in UIN Malik Ibrahim Malang. The type of research used is descriptive with quantitative approach. To increase the depth of respondents' answers, we used additional data by conducting interviews. The selected population is 322 students, class of 2012 to 2014, using random sampling. The selection criteria were chosen because the introduction and use of reference management software, zotero have started since three years ago. Respondents in this study as many as 80 people, which is obtained from the formula Yamane. The results showed that 70% agreed that using reference management software saved time and energy in managing digital file metadata, 71% agreed that if digital metadata can be quickly stored into RMS, 65% agreed on the ease of storing metadata into the reference management software, 70% agreed when it was easy to configure metadata to quote and bibliography, 56.6% agreed that the metadata stored in reference management software could be edited, 73.8% agreed that using metadata will make it easier to write quotes and bibliography.
van Jaarsveld, Cornelia H M; Gulliford, Martin C
This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. Cohort study of primary care electronic health records. 375 general practices in England that contribute to the UK Clinical Practice Research Datalink. Individual participants were sampled if they were aged between 2 and 15 years during the period 1994-2013 and had one or more records of body mass index (BMI). Prevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population. Data were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (-0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2-10 year) but not older (11-15 year) age group, where rates continued to increase. Primary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Fuji, Kevin T; Abbott, Amy A; Galt, Kimberly A
Patient use of personal health records (PHRs) to manage their health information has been proposed to enhance patient knowledge and empower patients to make changes in their self-care behaviors. However, there remains a gap in understanding about patients' actual PHR use behaviors. The purpose of this qualitative study was to explore how patients with type 2 diabetes used a PHR to manage their diabetes-related health information for self-care. Fifty-nine patients with type 2 diabetes were interviewed 3-6 months after receiving initial training on a free-of-charge, Web-based PHR. Interviews were audio-recorded, transcribed, and analyzed using an iterative process of in vivo coding, categorization, and theme development. Nine themes emerged, three of which expressed positive experiences: complete and accessible record; increased awareness; and behavioral changes. The remaining six themes expressed negative experiences: out of sight, out of mind; I would have used it if I were sicker; economic, infrastructure, and computer literacy barriers; lack of patient-provider engagement; double tracking; and privacy and security concerns. Despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. Provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.
Calisto, A; Bramanti, A; Galeano, M; Angileri, F; Campobello, G; Serrano, S; Azzerboni, B
The objective of this study is to investigate Id-iopatic Normal Pressure Hydrocephalus (INPH) through a multidimensional and multiparameter analysis of statistical data obtained from accurate analysis of Intracranial Pressure (ICP) recordings. Such a study could permit to detect new factors, correlated with therapeutic response, which are able to validate a predicting significance for infusion test. The algorithm developed by the authors computes 13 ICP parameter trends on each of the recording, afterward 9 statistical information from each trend is determined. All data are transferred to the datamining software WEKA. According to the exploited feature-selection techniques, the WEKA has revealed that the most significant statistical parameter is the maximum of Single-Wave-Amplitude: setting a 27 mmHg threshold leads to over 90% of correct classification.
Mala, George; Spigt, Mark G; Gidding, Luc G; Blanco, Roman; Dinant, Geert-Jan
To determine quality of diagnosis and monitoring of treatment response of patients with smear-negative pulmonary tuberculosis (TB) compared with smear-positive cases in Ethiopia. A retrospective analysis of medical records of newly diagnosed pulmonary TB cases that were registered for taking anti-TB medication and had completed treatment between 2010 and 2012. We evaluated the percentage of cases that were managed according to the International Standards of Tuberculosis Care (ISTC) and compared smear-negative with smear-positive cases. We analysed 1168 cases of which 742 (64%) were sputum smear-negative cases. Chest radiography examination at diagnosis and microbiological testing at the end of the intensive phase of treatment was performed in a smaller proportion than in smear-positive TB cases (70% vs. 79%, P value ISTC are of greatest importance in minimising pitfalls in care of smear-negative TB yet were performed less often in smear-negative than smear-positive TB cases. © The Author(s) 2015.
Namulanda, Gonza; Qualters, Judith; Vaidyanathan, Ambarish; Roberts, Eric; Richardson, Max; Fraser, Alicia; McVeigh, Katharine H; Patterson, Scott
Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. Published by Elsevier Inc.
van Gelder, Marleen M H J; Schouten, Naomi P E; Merkus, Peter J F M; Verhaak, Chris M; Roeleveld, Nel; Roukema, Jolt
Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman's general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0
Tromp, M.; van Eijsden, M.; Ravelli, A. C. J.; Bonsel, G. J.
Selective non-response is an important threat to study validity as it can lead to selection bias. The Amsterdam Born Children and their Development study (ABCD-study) is a large cohort study addressing the relationship between life style, psychological conditions, nutrition and sociodemographic
Full Text Available Abstract Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
Full Text Available In the Netherlands, the postal code is needed to study hospitalizations of individuals in the nationwide hospitalization register. Studying hospitalizations longitudinally becomes troublesome if individuals change address. We aimed to report on the feasibility and validity of a two-step medical record linkage approach to examine longitudinal trends in hospitalizations and mortality in a study cohort. First, we linked a study cohort of 1564 survivors of childhood cancer with the Municipal Personal Records Database (GBA which has postal code history and mortality data available. Within GBA, we sampled a reference population matched on year of birth, gender and calendar year. Second, we extracted hospitalizations from the Hospital Discharge Register (LMR with a date of discharge during unique follow-up (based on date of birth, gender and postal code in GBA. We calculated the agreement of death and being hospitalized in survivors according to the registers and to available cohort data. We retrieved 1477 (94% survivors from GBA. Median percentages of unique/potential follow-up were 87% (survivors and 83% (reference persons. Characteristics of survivors and reference persons contributing to unique follow-up were comparable. Agreement of hospitalization during unique follow-up was 94% and agreement of death was 98%. In absence of unique identifiers in the Dutch hospitalization register, it is feasible and valid to study hospitalizations and mortality of individuals longitudinally using a two-step medical record linkage approach. Cohort studies in the Netherlands have the opportunity to study mortality and hospitalization rates over time. These outcomes provide insight into the burden of clinical events and healthcare use in studies on patients at risk of long-term morbidities.
Lanoisellé, M.; Fisher, R. E.; Sriskantharajah, S.; Lowry, D.; Fowler, C. M. R.; Nisbet, E. G.
Atmospheric hydrogen (H2) and carbon monoxide (CO) have been measured at the Royal Holloway site, 30km WSW of London, for 12 years. This site receives air that has passed over London when there are easterly winds and cleaner, background air when the wind comes from the SW. H2 and CO mixing ratios are measured continuously at 30 minute intervals on a Trace Analytical Reduction Gas Detector coupled to a HP5890 GC since September 1996, and on a Peak Performer I (or PP1) since July 2007 at 5 minute intervals. Both instruments use 2 1/8" packed columns in series: a Unibeads 1S and a Molecular Sieve 5A. The PP1 detector (Reduced Compound Photometer) is an updated version of the old RGD2, and both use zero air as the carrier gas. CO is calibrated twice a month against NOAA-CMDL standards (mixing ratios range: 186 to 300 ppb). H2 was uncalibrated until 2006, but is now calibrated monthly against internal standards (range 530 to 750 ppb) measured at MPI-Jena as part of the Eurohydros project. A linearity correction is applied to each instrument, based on the standard measurements. A secondary standard is measured before each sample on the GC-RGD and another one is measured 4 to 6 times in a row twice a day on the PP1. A target gas is measured daily on both instruments since September 2008. The secondary standards and the target gas are dry ambient air in 70L stainless steel tanks filled to a pressure of 8 bars. Comparison of results from the two instruments suggests that for the most part the data are in good agreement, but an interlaboratory round robin comparison exercise for the Eurohydros project showed that the RGD is not linear at low values of CO. This is particularly noticeable for CO levels below 150 ppb. The long-term record of CO at Royal Holloway shows a significant decline since the start of the record: the annual mean CO mixing ratio in 2008 was three times lower than in 1997. Flux calculations, by ratio against 222Rn, CH4 and CO2, suggest CO emissions
Roumeliotis, Nadia; Parisien, Geneviève; Charette, Sylvie; Arpin, Elizabeth; Brunet, Fabrice; Jouvet, Philippe
To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. A prospective, observational, time-motion study. A level 3 PICU. Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013. The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare). Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48-72%]) and after (55% [interquartile range, 51-57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30-37%) before to 34.7% (interquartile range, 33-75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23-41%) to 18.6% (interquartile range, 16-22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12-22%) to 26.2% (interquartile range, 23-28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit. The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly
Tu, Rui; Zhang, Pengfei; Zhang, Rui; Liu, Jinhai
This paper has studied the key issues about integration of GNSS and strong-motion records for real-time earthquake monitoring. The validations show that the consistence of the coordinate system must be considered firstly to exclude the system bias between GNSS and strong-motion. The GNSS sampling rate is suggested about 1-5 Hz, and we should give the strong-motion's baseline shift with a larger dynamic noise as its variation is very swift. The initialization time of solving the baseline shift is less than one minute, and ambiguity resolution strategy is not greatly improved the solution. The data quality is very important for the solution, we advised to use multi-frequency and multi-system observations. These ideas give an important guide for real-time earthquake monitoring and early warning by the tight integration of GNSS and strong-motion records.
New records of nematode species in Brazil, which appeared after or were not mentioned in the last review, are shown in this paper. All environments were considered, including the continental margin. In addition, all studies on marine nematodes in Brazil, including grey literature, ecological papers and book chapters, are listed. Furthermore, information on genera/species richness, dominant genera, and densities is also presented. A total of 11 orders, 72 families, 372 genera, and 450 species of nematodes were recorded in Brazilian marine environments by April 2017. Following problems are discussed: taxonomic lists available only in grey literature, use of outdated identification keys (leading to incorrect identifications), and identifications mostly to putative species or to the genus level.
Full Text Available Abstract Background Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions and views relating to development of EHR for healthcare, health services planning and policy and health research. Methods/design A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. Discussion The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses. Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20. We discuss details of how we collected the data to provide insight into how we obtained this unusually high
Full Text Available Timely pathology results are critical for appropriate diagnosis and management of patients. Yet workflows in laboratories remain ad hoc and involve accessing multiple systems with no direct linkage between patient history and prior or pending pathology records for the case being analyzed. A major hindrance in timely reporting of pathology results is the need to incorporate/interface with multiple electronic health records (EHRs. We evaluated the Illuminate PatientView software (Illuminate integration into pathologist's workflow. Illuminate is a search engine architecture that has a repository of textual information from many hospital systems. Our goal was to develop a comprehensive, user friendly patient summary display to integrate the current fractionated subspecialty specific systems. An analytical time study noting changes in turnaround time (TAT before and after Illuminate implementation was recorded for reviewers, including pathologists, residents and fellows. Reviewers' TAT for 359 cases was recorded (200 cases before and 159 after implementation. The impact of implementing Illuminate on transcriptionists’ workflow was also studied. Average TAT to retrieve EHRs prior to Illuminate was 5:32 min (range 1:35-10:50. That time was significantly reduced to 35 seconds (range 10 sec-1:10 min using Illuminate. Reviewers were very pleased with the ease in accessing information and in eliminating the draft paper documents of the pathology reports, eliminating up to 65 min/day (25-65 min by transcriptionists matching requisition with paperwork. Utilizing Illuminate improved workflow, decreased TAT and minimized cost. Patient care can be improved through a comprehensive patient management system that facilitates communications between isolated information systems.
Chromá, Kateřina; Brázdil, Rudolf; Valášek, Hubert; Zahradníček, Pavel
Meteorological and hydrological extremes (MHEs) cause great material damage or even loss of human lives in the present time, similarly as it was in the past. In the Czech Lands (recently the Czech Republic), systematic meteorological and hydrological observations started generally in the latter half of the 19th century. Therefore, in order to create long-term series of such extremes, it is necessary to search for other sources of information. Different types of documentary evidence are used in historical climatology and hydrology to find such information. Some of them are related to records connected with taxation system. The taxation system in Moravia allowed farmers to request tax relief if their crops have been damaged by MHEs. The corresponding documents contain information about the type of extreme event and the date of its occurrence; often also impacts on crops or land may be derived. The nature of events leading to damage include particularly hailstorms, torrential rain, flash floods, floods (in regions along larger rivers), less frequently windstorms, late frosts and in some cases also information about droughts or extreme snow depths. However, the results obtained are influenced by uncertainties related to taxation records - their temporal and spatial incompleteness, limitation of the MHEs occurrence in the period of main agricultural work (May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about MHEs was of secondary importance). All these aspects related to the study of MHEs from taxation records are demonstrated for five estates (Bítov, Budkov, Jemnice with Staré Hobzí, Nové Syrovice and Uherčice) in the south-western part of Moravia for the 18th-19th centuries. The analysis shows importance of taxation records for the study of past MHEs as well as great potential for their use.
Riahi, Sanaz; Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John
Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. EMR implementation allowed Ontario Shores Centre for Mental Health
Ravelli , Anita C J; Tromp , Miranda; Van Huis , Marian M; Steegers , Eric A P; Tamminga , Pieter; Eskes , Martine; Bonsel , Gouke J
Abstract Background: The European PERISTAT-1 study showed that in 1999 perinatal mortality, especially fetal mortality, was substantially higher in the Netherlands when compared to other European countries. The aim of this study was to analyze the recent trend in Dutch perinatal mortality and the influence of risk factors. Methods: A nationwide retrospective cohort study of 1,246,440 singleton births in 2000-2006 in the Netherlands. The source data were available fro...
Background There is current interest in the role of perinatal factors in the aetiology of diseases that occur later in life. Infectious mononucleosis (IM) can follow late primary infection with Epstein-Barr virus (EBV), and has been shown to increase the risk of multiple sclerosis and Hodgkin's disease. Little is known about maternal or perinatal factors associated with IM or its sequelae. Methods We investigated perinatal risk factors for hospitalised IM using a prospective record-linkage study in a population in the south of England. The dataset used, the Oxford record linkage study (ORLS), includes abstracts of birth registrations, maternities and in-patient hospital records, including day case care, for all subjects in a defined geographical area. From these sources, we identified cases of hospitalised IM up to the age of 30 years in people for whom the ORLS had a maternity record; and we compared perinatal factors in their pregnancy with those in the pregnancy of children who had no hospital record of IM. Results Our data showed a significant association between hospitalised IM and lower social class (p = 0.02), a higher risk of hospitalised IM in children of married rather than single mothers (p < 0.001), and, of marginal statistical significance, an association with singleton birth (p = 0.06). The ratio of observed to expected cases of hospitalised IM in each season was 0.95 in winter, 1.02 in spring, 1.02 in summer and 1.00 in autumn. The chi-square test for seasonality, with a value of 0.8, was not significant. Other factors studied, including low birth weight, short gestational age, maternal smoking, late age at motherhood, did not increase the risk of subsequent hospitalised IM. Conclusions Because of the increasing tendency of women to postpone childbearing, it is useful to know that older age at motherhood is not associated with an increased risk of hospitalised IM in their children. We have no explanation for the finding that children of married women
White, Hollie; Bordo, Miguel; Chen, Sean
Written as a case study, this article outlines Duke Law School Information Services' video digitization, preservation, and access initiative. This article begins with a discussion of the case study environment and the cross-departmental evaluation of in-house video production and processing workflows. The in-house preservation reformatting process…
Peng, G.; Meier, W. N.; Scott, D. J.; Savoie, M. H.
A long-term, consistent, and reproducible satellite-based passive microwave sea ice concentration climate data record (CDR) is available for climate studies, monitoring, and model validation with an initial operation capability (IOC). The daily and monthly sea ice concentration data are on the National Snow and Ice Data Center (NSIDC) polar stereographic grid with nominal 25 km × 25 km grid cells in both the Southern and Northern Hemisphere polar regions from 9 July 1987 to 31 December 2007. The data files are available in the NetCDF data format at http://nsidc.org/data/g02202.html and archived by the National Climatic Data Center (NCDC) of the National Oceanic and Atmospheric Administration (NOAA) under the satellite climate data record program (http://www.ncdc.noaa.gov/cdr/operationalcdrs.html). The description and basic characteristics of the NOAA/NSIDC passive microwave sea ice concentration CDR are presented here. The CDR provides similar spatial and temporal variability as the heritage products to the user communities with the additional documentation, traceability, and reproducibility that meet current standards and guidelines for climate data records. The data set, along with detailed data processing steps and error source information, can be found at http://dx.doi.org/10.7265/N5B56GN3.
Karusisi, No?lla; Thomas, Fr?d?rique; M?line, Julie; Chaix, Basile
International audience; BACKGROUND: Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various i...
Full Text Available Objective: To study the morbidity pattern and relationship of these morbidities with socio-economic and demographic factors. Material and method: Present study was conducted at the Saraswathi Institute of Medical Sciences,Hapur,(U.P. among pregnant patients during the study period of one year. Data were analyzed using SPSS 16, using tabulation with percentage and Pearson's chi-square test was used for testing the crude associations. Results: In the present study a total of 338 pregnant women were included for the study material, out of which 67.46% of the antenatal women reported illness during antenatal period and majority 277(81.95% of the pregnant women were anemic.Thecommon non-obstetric morbidities reported were gastrointestinal disorder (24.68%, genital tuberculosis (16.88%, renal & gall bladder disease (7.79% and congenital anomaly (6.49% ect. (ii The obstetric morbidities included were pre-eclampsia(14.56%, urinary tract infection(9.71%, rupture of membrane(8.74%,hyperemesis gravidarum(9.22%and abnormal presentation in (2.43%patients . Conclusion: Maternal morbidity is notably high, although most of the common problems were not life-threatening. They are more likely to have marked influence on their wellbeing and health status in the long run. Most conditions could be addressed through provision of health promotion and preventive interventions.
Full Text Available Objective: To study the morbidity pattern and relationship of these morbidities with socio-economic and demographic factors. Material and method: Present study was conducted at the Saraswathi Institute of Medical Sciences,Hapur,(U.P. among pregnant patients during the study period of one year. Data were analyzed using SPSS 16, using tabulation with percentage and Pearson's chi-square test was used for testing the crude associations. Results: In the present study a total of 338 pregnant women were included for the study material, out of which 67.46% of the antenatal women reported illness during antenatal period and majority 277(81.95% of the pregnant women were anemic.Thecommon non-obstetric morbidities reported were gastrointestinal disorder (24.68%, genital tuberculosis (16.88%, renal & gall bladder disease (7.79% and congenital anomaly (6.49% ect. (ii The obstetric morbidities included were pre-eclampsia(14.56%, urinary tract infection(9.71%, rupture of membrane(8.74%,hyperemesis gravidarum(9.22%and abnormal presentation in (2.43%patients . Conclusion: Maternal morbidity is notably high, although most of the common problems were not life-threatening. They are more likely to have marked influence on their wellbeing and health status in the long run. Most conditions could be addressed through provision of health promotion and preventive interventions.
Draper, G.J. [University of Oxford (United Kingdom). Childhood Cancer Research Group; Little, M.P. [National Radiological Protection Board, Chilton (United Kingdom); Sorahan, T. [Birmingham University (United Kingdom). Inst. of Occupational Health] [and others
A national study has been conducted to test the Gardner hypothesis`, that childhood leukaemia and non-Hodgkin lymphoma can be caused by paternal exposure to ionising radiation before the conception of the child, and, more generally, to investigate whether preconception radiation exposure of either parent is a cause of childhood cancer. (UK).
Wagner, B.; Bennike, O.; Bos, J.A.A.; Cremer, H.; Lotter, A.F.; Melles, M.
Two sediment cores of 70 and 252 cm length were recovered from Hjort Sø, a small lake on Store Koldewey, Northeast Greenland, and studied with a multidisciplinary approach in order to reconstruct the local environmental history and to test the relevance of proxies for paleoenvironmental information.
Full Text Available The DNS, as one of the oldest components of the modern Internet, has been studied multiple times. It is a known fact that operational issues such as mis-configured name servers affect the responsiveness of the DNS service which could lead to delayed...
... work-study hours a claimant has completed. When a claimant elects to receive an advance payment, VA will advance payment for 50 hours, but will withhold benefits (to recoup the advance payment) until the...), Department of Veterans Affairs, will submit the collection of information abstracted below to the Office of...
Jonson-Reid, Melissa; Presnall, Ned; Drake, Brett; Fox, Louis; Bierut, Laura; Reich, Wendy; Kane, Phyllis; Todd, Richard D.; Constantino, John N.
Objective: Evidence is steadily accumulating that a preventable environmental hazard, child maltreatment, exerts causal influences on the development of long-standing patterns of antisocial behavior in humans. The relationship between child maltreatment and antisocial outcome, however, has never previously been tested in a large-scale study in…
Full Text Available Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference.In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent, sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss.Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62, normal hearing was correctly assessed in 92% of those with normal hearing (n = 249, and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112. Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid.Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results.
Scheinemann, Katrin; Grotzer, Michael; Kompis, Martin; Kuehni, Claudia E.
Background Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference. Procedure In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS) who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent), sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss. Results Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62), normal hearing was correctly assessed in 92% of those with normal hearing (n = 249), and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112). Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid. Conclusions Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results. PMID:28333999
Brázdil, Rudolf; Valášek, Hubert; Chromá, Kateřina; Dolák, Lukáš; Řezníčková, Ladislava; Dobrovolný, Petr
The taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrometeorological extremes. Firstly, the owners of land or individual farmers sent basic information about what had taken place, together with a detailed description of the damage, to the state executive (regional offices). After this, commissioners appointed by the regional administrator were obliged to inspect the places affected personally (in situ) and make records. Finally, the state executive made its decision as to whether to allow or reject the tax relief requested. The whole process was reflected in various surviving archival documents which contain information about the type of extreme event and the date of its occurrence, while the impact on crops may often be derived. Taxation documents of 201 estates in Southern Moravia, Czech Republic, prevailingly located in Moravian Land Archives in Brno, were studied to find information about hydrometeorological extremes. Such information is included for 84 of them. These data covering mainly the 18th-19th centuries were used for the study of historical floods (flash floods) complemented by other documentary sources and systematic hydrological observations (water stages, discharges) in the instrumental period (from the 1880s). Obtained flood data are analysed with respect to their temporal (frequency, seasonality) and spatial changes. Finally, uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance) are discussed with respect to results obtained. Taxation records constitute an important source of data for the study of historical floods with a great potential to be used in many European countries.
Handel Adam E
Full Text Available Abstract Background Venous thromboembolism (VTE is a common complication during and after a hospital admission. Although it is mainly considered a complication of surgery, it often occurs in people who have not undergone surgery, with recent evidence suggesting that immune-mediated diseases may play a role in VTE risk. We, therefore, decided to study the risk of deep vein thrombosis (DVT and pulmonary embolism (PE in people admitted to hospital with a range of immune-mediated diseases. Methods We analysed databases of linked statistical records of hospital admissions and death certificates for the Oxford Record Linkage Study area (ORLS1:1968 to 1998 and ORLS2:1999 to 2008 and the whole of England (1999 to 2008. Rate ratios for VTE were determined, comparing immune-mediated disease cohorts with comparison cohorts. Results Significantly elevated risks of VTE were found, in all three populations studied, in people with a hospital record of admission for autoimmune haemolytic anaemia, chronic active hepatitis, dermatomyositis/polymyositis, type 1 diabetes mellitus, multiple sclerosis, myasthenia gravis, myxoedema, pemphigus/pemphigoid, polyarteritis nodosa, psoriasis, rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Rate ratios were considerably higher for some of these diseases than others: for example, for systemic lupus erythematosus the rate ratios were 3.61 (2.36 to 5.31 in the ORLS1 population, 4.60 (3.19 to 6.43 in ORLS2 and 3.71 (3.43 to 4.02 in the England dataset. Conclusions People admitted to hospital with immune-mediated diseases may be at an increased risk of subsequent VTE. Our findings need independent confirmation or refutation; but, if confirmed, there may be a role for thromboprophylaxis in some patients with these diseases.
Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik
,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors......BACKGROUND: Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined...... the relationship between ABO blood group and dementia-related disorders in detail. METHODS: We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient...
Robotham, Dan; Evans, Joanne; Watson, Andrew; Perdue, Iain; Craig, Thomas; Rose, Diana; Wykes, Til
INTRODUCTION: Patients can provide consent to have their clinical records linked to a research register, a process known as consent for contact (C4C). There is evidence about how to engage people with mental illness in C4C, but nothing specific to older adults. This is a priority area for research (for example, dementia trials), although sign-up rates to C4C are lower than for younger populations. Through this study we seek to understand these disparities.METHODS: This was a two-stage cross-s...
Ruether J Dean
Full Text Available Abstract Background The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Methods Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Discussion Consultation
Rankin, Judith; Cans, Christine; Garne, Ester
Aim Our aim was to determine the proportion of children with cerebral palsy (CP) who have a congenital anomaly (CA) in three regions (Isère Region, French Alps; Funen County, Denmark; Northern Region, England) where population-based CP and CA registries exist, and to classify the children according...... to CA subtype. Method Data for children born between 1991 and 1999 were linked using electronic matching of cases. All potential matches were checked manually by each centre and verified as true matches. Results A total of 1104 children with CP were born during the study period (663 males, 441 females...
Kurtulus, Fidan Ana; Tomaskovic-Devey, Donald
The goal of this study is to examine whether women in the highest levels of firms' management ranks help reduce barriers to women's advancement in the workplace. Using a panel of over 20,000 private-sector firms across all industries and states during 1990-2003 from the U.S. Equal Employment Opportunity Commission, we explore the influence of women in top management on subsequent female representation in lower-level managerial positions in U.S. firms. Our key findings show that an increase in...
Metzger, Marie-Hélène; Tvardik, Nastassia; Gicquel, Quentin; Bouvry, Côme; Poulet, Emmanuel; Potinet-Pagliaroli, Véronique
The aim of this study was to determine whether an expert system based on automated processing of electronic health records (EHRs) could provide a more accurate estimate of the annual rate of emergency department (ED) visits for suicide attempts in France, as compared to the current national surveillance system based on manual coding by emergency practitioners. A feasibility study was conducted at Lyon University Hospital, using data for all ED patient visits in 2012. After automatic data extraction and pre-processing, including automatic coding of medical free-text through use of the Unified Medical Language System, seven different machine-learning methods were used to classify the reasons for ED visits into "suicide attempts" versus "other reasons". The performance of these different methods was compared by using the F-measure. In a test sample of 444 patients admitted to the ED in 2012 (98 suicide attempts, 48 cases of suicidal ideation, and 292 controls with no recorded non-fatal suicidal behaviour), the F-measure for automatic detection of suicide attempts ranged from 70.4% to 95.3%. The random forest and naïve Bayes methods performed best. This study demonstrates that machine-learning methods can improve the quality of epidemiological indicators as compared to current national surveillance of suicide attempts. Copyright © 2016 John Wiley & Sons, Ltd.
Full Text Available Abstract Background Aim of the study was to assess QTc interval by a 24-hour ECG recording in a group of HIV-infected individuals with a basal prolonged QTc. The risk factors associated with QTc prolongation and the indices of cardiovascular autonomic control were also evaluated. Methods A case–control study was performed using as cases 32 HIV-infected patients with prolonged (>440 msec QTc interval as assessed by Holter ECG, and as controls 64 HIV-infected subjects with normal QTc interval. Autonomic function was evaluated by heart rate variability analysis during 24-hour recording. Results Duration of HIV disease was significantly longer among cases than among controls (p=0.04. Waist/hip ratio was also higher among cases than among controls (p=0.05. Frequency domain analysis showed the absence of physiologic decrease of low frequency (LF in the night period in both cases and controls. The LF night in cases showed a statistically significant reduction when compared with controls (p=0.007. Conclusions In our study group, QTc interval prolongation was associated with a longer duration of HIV infection and with a greater waist/hip ratio. HIV patients with QTc interval prolongation and with a longer duration of HIV infection were more likely to have an impairment of parasympathetic and sympathetic cardiac component.
Draper, G.J. [Childhood Cancer Research Group, University of Oxford (United Kingdom); Little, M.P. [National Radiological Protection Board, Chilton (United Kingdom); Sorahan, T. [Institute of Occupational Health, University of Birmingham (United Kingdom)] [and others
The objectives of this study were to test the `Gardner hypothesis` that childhood leukaemia and non-Hodgkin lymphoma can be caused by paternal exposure to ionising radiation before the conception of the child, and more generally, to investigate whether such radiation exposure of either parent is a cause of childhood cancer. This was a case-control study, conducted in Great Britain, that involved 35,949 children diagnosed as having cancer, together with matched controls. Examination was made of: parental employment as radiation worker as defined by inclusion in the National Registry for Radiation Workers and being monitored for external radiation before conception of child; cumulative dose of external ionising radiation for various periods of employment before conception; pregnancy dose. It is concluded that the results do not support the hypothesis that paternal preconception irradiation is a cause of childhood leukaemia and non-Hodgkin lymphoma; the observed associations may be chance or result from exposure to infective or other agents. If there is any increased risk for the children of fathers who are radiation workers it is small in absolute terms: in Britain the average risk by age 15 years is 6.5 per 10,000; our best estimate, using all available data, is that the increase is 5.4 per 10,000. For mothers, the numbers are too small for reliable estimates of the risk, if any, to be made. (author).
Draper, G.J.; Little, M.P.; Sorahan, T.
The objectives of this study were to test the 'Gardner hypothesis' that childhood leukaemia and non-Hodgkin lymphoma can be caused by paternal exposure to ionising radiation before the conception of the child, and more generally, to investigate whether such radiation exposure of either parent is a cause of childhood cancer. This was a case-control study, conducted in Great Britain, that involved 35,949 children diagnosed as having cancer, together with matched controls. Examination was made of: parental employment as radiation worker as defined by inclusion in the National Registry for Radiation Workers and being monitored for external radiation before conception of child; cumulative dose of external ionising radiation for various periods of employment before conception; pregnancy dose. It is concluded that the results do not support the hypothesis that paternal preconception irradiation is a cause of childhood leukaemia and non-Hodgkin lymphoma; the observed associations may be chance or result from exposure to infective or other agents. If there is any increased risk for the children of fathers who are radiation workers it is small in absolute terms: in Britain the average risk by age 15 years is 6.5 per 10,000; our best estimate, using all available data, is that the increase is 5.4 per 10,000. For mothers, the numbers are too small for reliable estimates of the risk, if any, to be made. (author)
Panagiotis C. Pelekis,; Savvaidis, Alexandros; Kayen, Robert E.; Vlachakis, Vasileios S.; Athanasopoulos, George A.
Surface wave method was used for the estimation of Vs vs depth profile at 10 strong motion stations in Greece. The dispersion data were obtained by SASW method, utilizing a pair of electromechanical harmonic-wave source (shakers) or a random source (drop weight). In this study, three inversion techniques were used a) a recently proposed Simplified Inversion Method (SIM), b) an inversion technique based on a neighborhood algorithm (NA) which allows the incorporation of a priori information regarding the subsurface structure parameters, and c) Occam's inversion algorithm. For each site constant value of Poisson's ratio was assumed (ν=0.4) since the objective of the current study is the comparison of the three inversion schemes regardless the uncertainties resulting due to the lack of geotechnical data. A penalty function was introduced to quantify the deviations of the derived Vs profiles. The Vs models are compared as of Vs(z), Vs30 and EC8 soil category, in order to show the insignificance of the existing variations. The comparison results showed that the average variation of SIM profiles is 9% and 4.9% comparing with NA and Occam's profiles respectively whilst the average difference of Vs30 values obtained from SIM is 7.4% and 5.0% compared with NA and Occam's.
Zienkiewicz, Aleksandra; Huotari, Niko; Raitamaa, Lauri; Raatikainen, Ville; Ferdinando, Hany; Vihriälä, Erkki; Korhonen, Vesa; Myllylä, Teemu; Kiviniemi, Vesa
The lymph system is responsible for cleaning the tissues of metabolic waste products, soluble proteins and other harmful fluids etc. Lymph flow in the body is driven by body movements and muscle contractions. Moreover, it is indirectly dependent on the cardiovascular system, where the heart beat and blood pressure maintain force of pressure in lymphatic channels. Over the last few years, studies revealed that the brain contains the so-called glymphatic system, which is the counterpart of the systemic lymphatic system in the brain. Similarly, the flow in the glymphatic system is assumed to be mostly driven by physiological pulsations such as cardiovascular pulses. Thus, continuous measurement of blood pressure and heart function simultaneously with functional brain imaging is of great interest, particularly in studies of the glymphatic system. We present our MRI compatible optics based sensing system for continuous blood pressure measurement and show our current results on the effects of blood pressure variations on cerebral brain dynamics, with a focus on the glymphatic system. Blood pressure was measured simultaneously with near-infrared spectroscopy (NIRS) combined with an ultrafast functional brain imaging (fMRI) sequence magnetic resonance encephalography (MREG, 3D brain 10 Hz sampling rate).
Matthewman, Richard; Court, Richard W; Crawford, Ian A; Jones, Adrian P; Joy, Katherine H; Sephton, Mark A
The organic record of Earth older than ∼3.8 Ga has been effectively erased. Some insight is provided to us by meteorites as well as remote and direct observations of asteroids and comets left over from the formation of the Solar System. These primitive objects provide a record of early chemical evolution and a sample of material that has been delivered to Earth's surface throughout the past 4.5 billion years. Yet an effective chronicle of organic evolution on all Solar System objects, including that on planetary surfaces, is more difficult to find. Fortunately, early Earth would not have been the only recipient of organic matter-containing objects in the early Solar System. For example, a recently proposed model suggests the possibility that volatiles, including organic material, remain archived in buried paleoregolith deposits intercalated with lava flows on the Moon. Where asteroids and comets allow the study of processes before planet formation, the lunar record could extend that chronicle to early biological evolution on the planets. In this study, we use selected free and polymeric organic materials to assess the hypothesis that organic matter can survive the effects of heating in the lunar regolith by overlying lava flows. Results indicate that the presence of lunar regolith simulant appears to promote polymerization and, therefore, preservation of organic matter. Once polymerized, the mineral-hosted newly formed organic network is relatively protected from further thermal degradation. Our findings reveal the thermal conditions under which preservation of organic matter on the Moon is viable.
Hall, Dorothy K.; Comiso, Josefino C.; Shuman, Christopher A.; Koenig, Lora S.; DiGirolamo, Nicolo E.
Enhanced melting of the Greenland Ice Sheet has been documented in recent literature along with surface-temperature increases measured using infrared satellite data since 1981. Using a recently-developed climate-quality data record, 11- and 12-year trends in the clear-sky ice-surface temperature (IST) of the Greenland Ice Sheet have been studied using the Moderate-Resolution Imaging Spectroradiometer (MODIS) IST product. Daily and monthly MODIS ISTs of the Greenland Ice Sheet beginning on 1 March 2000 and continuing through 31 December 2010 are now available at 6.25-km spatial resolution on a polar stereographic grid as described in Hall et al. (submitted). This record will be elevated in status to a climate-data record (CDR) when more years of data become available either from the MODIS on the Terra or Aqua satellites, or from the Visible Infrared Imager Radiometer Suite (VIIRS) to be launched in October 2011. Maps showing the maximum extent of melt for the entire ice sheet and for the six major drainage basins have been developed from the MODIS IST dataset. Twelve-year trends of the duration of the melt season on the ice sheet vary in different drainage basins with some basins melting progressively earlier over the course of the study period. Some (but not all) of the basins also show a progressively-longer duration of melt. IST 12-year trends are compared with in-situ data, and climate data from the Modern Era Retrospective-Analysis for Research and Applications (MERRA) Reanalysis.
Stephen E Roberts
Full Text Available Increased mortality following hospitalisation for stroke has been reported from many but not all studies that have investigated a 'weekend effect' for stroke. However, it is not known whether the weekend effect is affected by factors including hospital size, season and patient distance from hospital.To assess changes over time in mortality following hospitalisation for stroke and how any increased mortality for admissions on weekends is related to factors including the size of the hospital, seasonal factors and distance from hospital.A population study using person linked inpatient, mortality and primary care data for stroke from 2004 to 2012. The outcome measures were, firstly, mortality at seven days and secondly, mortality at 30 days and one year.Overall mortality for 37 888 people hospitalised following stroke was 11.6% at seven days, 21.4% at 30 days and 37.7% at one year. Mortality at seven and 30 days fell significantly by 1.7% and 3.1% per annum respectively from 2004 to 2012. When compared with week days, mortality at seven days was increased significantly by 19% for admissions on weekends, although the admission rate was 21% lower on weekends. Although not significant, there were indications of increased mortality at seven days for weekend admissions during winter months (31%, in community (81% rather than large hospitals (8% and for patients resident furthest from hospital (32% for distances of >20 kilometres. The weekend effect was significantly increased (by 39% for strokes of 'unspecified' subtype.Mortality following stroke has fallen over time. Mortality was increased for admissions at weekends, when compared with normal week days, but may be influenced by a higher stroke severity threshold for admission on weekends. Other than for unspecified strokes, we found no significant variation in the weekend effect for hospital size, season and distance from hospital.
Senthil K Vasan
Full Text Available Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail.We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models.Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98, compared to those with blood group O.Our results provide no evidence that ABO blood group influences the risk of dementia.
Lachaud, James; Donnelly, Peter D; Henry, David; Kornas, Kathy; Calzavara, Andrew; Bornbaum, Catherine; Rosella, Laura
Homicide - a lethal expression of violence - has garnered little attention from public health researchers and health policy makers, despite the fact that homicides are a cause of preventable and premature death. Identifying populations at risk and the upstream determinants of homicide are important for addressing inequalities that hinder population health. This population-based study investigates the public health significance of homicides in Ontario, Canada, over the period of 1999-2012. We quantified the relative burden of homicides by comparing the socioeconomic gradient in homicides with the leading causes of death, cardiovascular disease (CVD) and neoplasm, and estimated the potential years of life lost (PYLL) due to homicide. We linked vital statistics from the Office of the Registrar General Deaths register (ORG-D) with Census and administrative data for all Ontario residents. We extracted all homicide, neoplasm, and cardiovascular deaths from 1999 to 2012, using International Classification of Diseases codes. For socioeconomic status (SES), we used two dimensions of the Ontario Marginalization Index (ON-Marg): material deprivation and residential instability. Trends were summarized across deprivation indices using age-specific rates, rate ratios, and PYLL. Young males, 15-29 years old, were the main victims of homicide with a rate of 3.85 [IC 95%: 3.56; 4.13] per 100,000 population and experienced an upward trend over the study period. The socioeconomic neighbourhood gradient was substantial and higher than the gradient for both cardiovascular and neoplasms. Finally, the PYLL due to homicide were 63,512 and 24,066 years for males and females, respectively. Homicides are an important cause of death among young males, and populations living in disadvantaged neighbourhoods. Our findings raise concerns about the burden of homicides in the Canadian population and the importance of addressing social determinants to address these premature deaths.
Full Text Available Abstract Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability. In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations. Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability. These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.
Full Text Available Aims: 1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. Settings and Design: Comparative, cross-sectional and non-interventional study. Methods and Material: It is retrospective, record-based study conducted upon inpatients (n = 200 of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. Statistical Analysis Used: Comparative analysis of specific and selective gaps were estimated in terms of percentage (%. Results: Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. Conclusions: The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.
Chatterjee, Sudeshna; Ray, Krishnangshu; Das, Anup Kumar
1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. Comparative, cross-sectional and non-interventional study. It is retrospective, record-based study conducted upon inpatients ( n = 200) of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. Comparative analysis of specific and selective gaps were estimated in terms of percentage (%). Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.
Hattingh, Hendrika Laetitia; Varsani, Janki; Kachouei, Leila Ataei; Parsons, Richard
A community pharmacy real-time electronic recording program, ProjectSTOP, enables Australian community pharmacists to verify pseudoephedrine requests. In Western Australia the program was available for voluntary use from April 2007 and became mandatory November 2010. This case study explores the effectiveness of the program by reviewing the total requests for pseudoephedrine products, and the proportion of requests which were classified as 'denied sales' before and after mandatory implementation. Seasonal and annual trends in these measures are also evaluated. ProjectSTOP data recordings for Western Australia pharmacies between 1 December 2007 and 28 February 2014 were analysed. Data included a de-identified pharmacy number and date of each pseudoephedrine product request. The total number of requests and sale classification (allowed, denied, safety, or not recorded) were calculated for each month/pharmacy. The potential influence of mandatory reporting using ProjectSTOP was investigated using a Regression Discontinuity Design. Correlations between sales from the same pharmacy were taken into account by classifying the pharmacy number as a random effect. The main effects of year (continuous variable), and season (categorical variable) were also included in the model. There was a small but steady decline in the total requests for pseudoephedrine per month per 100,000 population (per pharmacy) from the time of mandatory reporting. The number of denied sales showed a steady increase up until mandatory reporting, after which it showed a significant decline over time. Total sales were heavily influenced by season, as expected (highest in winter, least in summer). The seasonal pattern was less pronounced for denied sales, which were highest in winter and similar across other seasons. The pattern over time for safety sales was similar to that for denied sales, with a clear change occurring around the time of mandatory reporting. Results indicate a decrease in
Full Text Available In this paper we evalllate the seismic amplification effects in the town of Benevento llsing records of an explo- sion of 500 kg fired at abollt 7 km. Seismic records were obtained at 43 selected sites in the city by digital three-component stations. A data selection performed on the signal-to-noise ratio reduced the available data to 26 stations. We used the spectral ratio techniques to evaluate the amplification effects of each recording site compared both to the average spectrum calculated over 26 stations and to a reference seismic station. The shapes of the spectral ratios were classified according to the geological characteristics of the site. A characteristic shape of the spectral ratio was observed to be related to the specific structure of the subsoil. In particular, the sites on basin sediments (Lagonegro Unit and Middle Pleistocene conglomerates failed to show amplification effects; the sites on thick alluvial deposits showed amplification in the 5-9 Hz range; finally, sites on alluvial-lacustrine deposits amplified the seismic signal at frequencies depending on the characteristics and the thickness of the deposit. In addition, damage distribution caused by the 1688 earthquake in Benevento was related to the thickness of the surface layers in the ancient built-up area of the town. The study of the spectral ra- tios showed that these deposits amplify ground motion at frequencies between 9 and 12 Hz, i.e. frequencies close to the natural period of the most widespread buildings at that time in Benevento. Geological and seismic data were jointly used to carry out a zonation of the urban area of Benevento on the basis of homogeneous seismic responses. The validity of this analysis is limited to the main frequency band and amplitude of ground motion produced by the explosions.
Comparing the Use of Books with Enhanced Records versus Those Without Enhancements: Methodology Leads to Questionable Conclusions. A review of: Madarash‐Hill, Cherie and J.B. Hill. “Electronically Enriched Enhancements in Catalog Records: A Use Study of Books Described on Records With URL Enhancements Versus Those Without.” Technical Services Quarterly 23.2 (2005: 19‐31.
Full Text Available Objective – To compare the use of books described by catalogue records that are enhanced with URL links to such information as dust jackets, tables of contents, sample text, and publishers’ descriptions, with the use of books described by records that are not enhanced with such links.Design – Use study.Setting – Academic library (Southeastern Louisiana University, Sims Memorial Library.Subjects – 180 records with enhancements and 180 records (different titles without enhancements.Methods – The study identified the sample of unenhanced records by conducting searches of the broad subject terms “History”, “United States”, “Education”,and “Social” and limiting the searches to books. The enhanced sample was derived in the same manner, but with additional search limiters to identify only those records that had URL enhancements. An equal sample of enhanced and unenhanced records (50 or 30 of each was tracked for each of four search terms. Only records for books that could be checked out were included, as use statistics were based on whether or not a book was borrowed. While half of the enhanced records had full‐text elements (such as descriptions that were indexed and thus searchable, the rate of use for these records was not tracked separately from the enhanced records that only had URL enhancements.Main results – Books described on records with URL enhancements for publisher descriptions, tables of contents, book reviews, or sample text had higher use than those without URL enhancements. Only 7% of titles with URLs, compared with 21% of those without, had not been borrowed. 74.67% of titles with URLs had been checked out one or two times, compared with 69.5% of those without URLs. The number of titles with enhanced records that had 3 or more checkouts was almost double the rate of unenhanced titles (18% to 9.5%.Conclusion – The authors conclude that catalogue records that have electronic links to book reviews, cover
Full Text Available In this study which carried out on trees and shrubs in forest phytocoenose of Rize province, fifty-one microfungi species have been identified as new record for mycobiota of our country. Sixteen genera have been determined as new record on level of genera among these species.
G. W. L. Gresik
Full Text Available The goal of RECORDS (Reaching Recording Data Technologies is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.
Gresik, G. W. L.; Siebe, S.; Drewello, R.
The goal of RECORDS (Reaching Recording Data Technologies) is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.
Shea Christopher M
Full Text Available Abstract Background Health information technology (HIT applications that incorporate point-of-care use of health-related quality of life (HRQL assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients. Methods Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff. Results The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1 duplicative of information gathered via other means during the encounter; (2 specific enough to be useful and/or acted upon, and; (3 useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information. Conclusions Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice
Ravindrarajah, Rathi; Hazra, Nisha C; Hamada, Shota; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C
Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life. © 2017 The Authors.
Whitt, Karen J; Eden, Lacey; Merrill, Katreena Collette; Hughes, Mckenna
Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.
Joseph, Rebecca M; Soames, Jamie; Wright, Mark; Sultana, Kirin; van Staa, Tjeerd P; Dixon, William G
To describe a novel observational study that supplemented primary care electronic health record (EHR) data with sample collection and patient diaries. The study was set in primary care in England. A list of 3974 potentially eligible patients was compiled using data from the Clinical Practice Research Datalink. Interested general practices opted into the study then confirmed patient suitability and sent out postal invitations. Participants completed a drug-use diary and provided saliva samples to the research team to combine with EHR data. Of 252 practices contacted to participate, 66 (26%) mailed invitations to patients. Of the 3974 potentially eligible patients, 859 (22%) were at participating practices, and 526 (13%) were sent invitations. Of those invited, 117 (22%) consented to participate of whom 86 (74%) completed the study. We have confirmed the feasibility of supplementing EHR with data collected directly from patients. Although the present study successfully collected essential data from patients, it also underlined the requirement for improved engagement with both patients and general practitioners to support similar studies. © 2017 The Authors. Pharmacoepidemiology & Drug Safety published by John Wiley & Sons Ltd.
Mevik, Kjersti; Griffin, Frances A; Hansen, Tonje E; Deilkås, Ellen T; Vonen, Barthold
To investigate the impact of increasing sample of records reviewed bi-weekly with the Global Trigger Tool method to identify adverse events in hospitalised patients. Retrospective observational study. A Norwegian 524-bed general hospital trust. 1920 medical records selected from 1 January to 31 December 2010. Rate, type and severity of adverse events identified in two different samples sizes of records selected as 10 and 70 records, bi-weekly. In the large sample, 1.45 (95% CI 1.07 to 1.97) times more adverse events per 1000 patient days (39.3 adverse events/1000 patient days) were identified than in the small sample (27.2 adverse events/1000 patient days). Hospital-acquired infections were the most common category of adverse events in both the samples, and the distributions of the other categories of adverse events did not differ significantly between the samples. The distribution of severity level of adverse events did not differ between the samples. The findings suggest that while the distribution of categories and severity are not dependent on the sample size, the rate of adverse events is. Further studies are needed to conclude if the optimal sample size may need to be adjusted based on the hospital size in order to detect a more accurate rate of adverse events. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Williams, Rachael; van Staa, Tjeerd-Pieter; Gallagher, Arlene M; Hammad, Tarek; Leufkens, Hubert G M; de Vries, Frank
Conflicting results from studies using electronic health records to evaluate the associations between type 2 diabetes and cancer fuel concerns regarding potential biases. This study aimed to describe completeness of cancer recording in UK primary care data linked to hospital admissions records. Patients aged 40+ years with insulin or oral antidiabetic prescriptions in Clinical Practice Research Datalink (CPRD) primary care without type 1 diabetes were matched by age, sex and general practitioner practice to non-diabetics. Those eligible for linkage to Hospital Episode Statistics Admitted Patient Care (HES APC), and with follow-up during April 1997-December 2006 were included. Cancer recording and date of first record of cancer were compared. Characteristics of patients with cancer most likely to have the diagnosis recorded only in a single data source were assessed. Relative rates of cancer estimated from the two datasets were compared. 53 585 patients with type 2 diabetes matched to 47 435 patients without diabetes were included. Of all cancers (excluding non-melanoma skin cancer) recorded in CPRD, 83% were recorded in HES APC. 94% of cases in HES APC were recorded in CPRD. Concordance was lower when restricted to same-site cancer records, and was negatively associated with increasing age. Relative rates for cancer were similar in both datasets. Good concordance in cancer recording was found between CPRD and HES APC among type 2 diabetics and matched controls. Linked data may reduce misclassification and increase case ascertainment when analysis focuses on site-specific cancers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Hsu, Fang-Ming; Hu, Paul Jen-Hwa; Chen, Hsinchun; Hu, Han-Fen
While e-government is propelling and maturing steadily, advanced technological capabilities alone cannot guarantee agencies’ realizing the full benefits of the enabling computer-based systems. This study analyzes information systems in e-government settings by examining agencies’ satisfaction with an electronic record management system (ERMS). Specifically, we investigate key satisfaction determinants that include regulatory compliance, job relevance, and satisfaction with support services for using the ERMS. We test our model and the hypotheses in it, using a large-scale survey that involves a total of 1,652 government agencies in Taiwan. Our results show significant effects of regulatory compliance on job relevance and satisfaction with support services, which in turn determine government agencies’ satisfaction with an ERMS. Our data exhibit a reasonably good fit to our model, which can explain a significant portion of the variance in agencies’ satisfaction with an ERMS. Our findings have several important implications to research and practice, which are also discussed.
Hilden, Wolfgang; )
Preservation of RK and M starts in the pre-closure phase. A comprehensive waste inventory is required which needs to be maintained over significantly long time spans before RWM has reached the step of disposal. Since long term management solutions are often not clearly defined, disposal acceptance criteria are and cannot be known beforehand, at least not in early stages of disposal programs. Thus a Preservation of RK and M should therefore be approached within the rationale of life cycle analysis. There is a wide variety of approaches with regard to waste inventories at EU level, and retrieving data is often lengthy and difficult. The Commission dedicated a study to identify good practices and formulate recommendations. There are two main issues; firstly waste data collection, recording and reporting, and secondly record keeping and knowledge transfer. One concerns the present time, while the other is concerned with long periods of time. With regard to the analysis of data requirements, it was found that they depend on the context of their use, be it safe treatment, storage and disposal, policy making and capacity planning or funding. The study identifies for each use relevant data sets. Thus, the question of the purpose of RK and M preservation heavily influences the question of which records need to be maintained (cf. the RK and M Vision Document). This is also true with regard to the potential need to cope with changes of the regulatory system or overall RWM policy, which requires to preserve raw data in continuously accessible form. On the other hand the contextualization of data is needed, for which the safety case may be a useful tool. With regard to legacy waste, re-assessment or re-conditioning campaigns should aim at maximum information gain. Agreements on how to coherently account for the total volume of the waste need to be made. A balance needs to be found between completeness and overload (watch out for 'Keep everything, find nothing'). Data security
Klausner, Virginia; Papa, Andres; Mendes, Odim; Oliveira Domingues, Margarete
It is well known that any of the components of the magnetic field measured on the Earth's surface presents characteristic frequencies with 24, 12, 8 and 6-hour period. Those typical kinds of oscillations of the geomagnetic field are known as solar quiet variation and are primary due to the global thermotidal wind systems which conduct currents flowing in the "dynamo region" of the ionosphere, the E-region. In this study, the horizontal component amplitude observed by ground-based observatories belonged to the INTERMAGNET network have been used to analyze the global pattern variance of the Sq variation. In particular we focused our attention on Vassouras Observatory (VSS), Rio de Janeiro, Brazil, which has been active since 1915. In the next years, a brazilian network of magnetometers will be implemented and VSS can be used as reference. This work aims mainly to highlight and interpret these quiet daily variations over the Brazilian sector compared to the features from other magnetic stations reasonably distributed over the whole Earth's surface. The methodological approach is based on wavelet cross-correlation technique. This technique is useful to isolate the period of the spectral components of geomagnetic field in each station and to correlate them as function of scale (period) between VSS and the other stations. The wavelet cross-correlation coefficient strongly depends on the scale. We study the geomagnetically quiet days at equinox and solstice months during low and high solar activity. As preliminary remarks, the results show that the records in the magnetic stations have primary a latitudinal dependence affected by the time of year and level of solar activity. On the other hand, records of magnetic stations located at the same dip latitude but at different longitude presented some peculiarities. These results indicated that the winds driven the dynamo are very sensitive of the location of the geomagnetic station, i. e., its effects depend upon the direction
Roberts, Christine L; Algert, Charles S; Morris, Jonathan M; Ford, Jane B
Since the 1990s, pregnancy hypertension rates have declined in some countries, but not all. Increasing rates of early planned delivery (before the due date) have been hypothesised as the reason for the decline. The aim of this study was to explore whether early planned delivery can partly explain the declining pregnancy hypertension rates in Australia. Population-based record linkage study utilising linked birth and hospital records. A cohort of 1,076,122 deliveries in New South Wales, Australia, 2001-2012. Pregnancy hypertension (including gestational hypertension, pre-eclampsia and eclampsia) was the main outcome; pre-eclampsia was a secondary outcome. From 2001 to 2012, pregnancy hypertension rates declined by 22%, from 9.9% to 7.7%, and pre-eclampsia by 27%, from 3.3% to 2.4% (trend prate was predicted to increase to 10.5%. Examination of annual gestational age distributions showed that pregnancy hypertension rates actually declined from 38 weeks gestation and were steepest from 41 weeks; at least 36% of the decrease could be attributed to planned deliveries. The risk factors for pregnancy hypertension were also risk factors for planned delivery. It appears that an unanticipated consequence of increasing early planned deliveries is a decline in the incidence of pregnancy hypertension. Women with risk factors for hypertension were relatively more likely to be selected for early delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Piltoft, Johanne Spanggaard; Larsen, Signe Benzon; Dalton, Susanne Oksbjerg; Johansen, Christoffer; Baker, Jennifer L; Cederkvist, Luise; Andersen, Ingelise
One established risk factors for testicular cancer is cryptorchidism. However, it remains unclear whether cryptorchidism is a risk factor in itself or whether the two conditions share common causes in early life (estrogen hypothesis), such as birth weight and birth order. The objective of this study is to utilize data from the Copenhagen School Health Records Register (CSHRR) to evaluate cryptorchidism, birth weight and birth order as risk factors for testicular cancer. The study population consisted of 408 cases of testicular cancer identified by a government issued identification number linkage of the entire CSHRR with the Danish Cancer Registry and a random subsample of 4819 males from the CSHRR. The study design was case-cohort and the period of follow-up between 2 April 1968 and 31 December 2003. Cryptorchidism was significantly associated with testicular cancer in crude analyses [hazard ratio (HR) = 3.60, 95% CI 2.79-4.65]. Birth weight was inversely associated with testicular cancer and no clear association with birth order was observed. The positive association between cryptorchidism and testicular cancer was only slightly attenuated controlling for birth weight and birth order and stratified on birth cohort (HR = 3.46, 95% CI 2.67-4.48). This study confirmed the robustness of the association between cryptorchidism and testicular cancer even after adjustment for birth weight and birth order. Furthermore, the study showed an inverse association between birth weight and testicular cancer.
Marcos, Mar; Maldonado, Jose A; Martínez-Salvador, Begoña; Boscá, Diego; Robles, Montserrat
Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support
Jeremiah S. Hinson
Full Text Available Introduction: Our goal was to reduce ordering of coagulation studies in the emergency department (ED that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR. Methods: We used a pre and post quasi-experimental study design to evaluate the impact of an EMRbased intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. Results: Pre-intervention, 73.8% (76/103 of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76 were non-value added. Post-intervention, 38.5% (40/104 of patients with chest pain had coagulation studies ordered, of which 60% (24/40 were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0% in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0% in non-value added order placement. Conclusion: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. [West J Emerg Med. 2017;18(2267-269.
Gill, James M; Klinkman, Michael S; Chen, Ying Xia
Because comorbid depression can complicate medical conditions (eg, diabetes), physicians may treat depression more aggressively in patients who have these conditions. This study examined whether primary care physicians prescribe antidepressant medications more often and in higher doses for persons with medical comorbidities. This secondary data analysis of electronic health record data was conducted in the Centricity Health Care User Research Network (CHURN), a national network of ambulatory practices that use a common outpatient electronic health record. Participants included 209 family medicine and general internal medicine providers in 40 primary care CHURN offices in 17 US states. Patients included adults with a new episode of depression that had been diagnosed during the period October 2006 through July 2007 (n = 1513). Prescription of antidepressant medication and doses of antidepressant medication were compared for patients with and without 6 comorbid conditions: diabetes, coronary heart disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, and cancer. 20.7% of patients had at least one medical comorbidity whereas 5.8% had multiple comorbidities. Overall, 77% of depressed patients were prescribed antidepressant medication. After controlling for age and sex, patients with multiple comorbidities were less likely to be prescribed medication (adjusted odds ratio, 0.58; 95% CI, 0.35-0.96), but there was no significant difference by individual comorbidities. Patients with cerebrovascular disease were less likely to be prescribed a full dose of medication (adjusted odds ratio, 0.26; 95% CI, 0.08-0.88), but there were no differences for other comorbidities or for multiple comorbidities, and there was no difference for any comorbidities in the prescription of minimally effective doses. Patients with new episodes of depression who present to a primary care practice are not treated more aggressively if they have medical
Saunders, M B; Gulabivala, K; Holt, R; Kahan, R S
The aim of this preliminary study was to test the reliability of radiographic evaluation of features of endodontic interest using a newly devised data collection system. Twelve endodontic MSc postgraduate students and one specialist endodontist examined sample radiographs derived from a random selection of 42 patients seen previously on an Endodontic New Patient Clinic (EDI). Each student examined a random selection of 8-9 roots on periapical radiographs of single- and multirooted teeth, with and without previous root canal therapy and 3-4 dental panoramic tomograms (DPTs). A total of 100 roots were examined. A proforma was used to record observations on 67 radiographic features using predefined criteria. Intra-observer agreement was tested by asking the students to re-examine the radiographs. The principle investigator and the specialist endodontist examined the same radiographs and devised a Gold Standard using the same criteria. This was compared with the student assessments to determine inter-observer variation. The postgraduates then attended a revision session on the use of the form. Each student subsequently examined 8-9 different roots from the pool of radiographs. A further assessment of inter-observer variation was made by comparing these observations with the Gold Standard. Of the 67 radiographic features, only 25 had sufficient response to allow statistical analysis. Kappa values for intra- and inter-observer variation were estimated. These varied depending on the particular radiographic feature being assessed. Fifteen out of 25 intra-observer recordings showed 'good' or 'very good' Kappa agreement, but only three out of 25 inter-observer observations achieved 'good' or 'very good' values. Inter-observer variation was improved following the revision session with 16 out of 25 observations achieving 'good' or 'very good' Kappa agreement. Modification to the proforma, the criteria used, and training for radiographic assessment were considered necessary to
Sollie, Annet; Sijmons, Rolf H; Helsper, Charles; Numans, Mattijs E
To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs) from 52 general practices was performed. Coded data from 2000 to 2011 for the three most common cancer types (breast, colon and prostate cancer) was compared to the Netherlands Cancer Registry. Data quality is expressed in Standard Incidence Ratios (SIRs): the ratio between the number of coded cases observed in the primary care network database and the expected number of cases based on the Netherlands Cancer Registry. Ratios were multiplied by 100% for readability. The overall SIR was 91.5% (95%CI 88.5-94.5) and showed improvement over the years. SIRs differ between cancer types: from 71.5% for colon cancer in males to 103.9% for breast cancer. There are differences in data quality (SIRs 76.2% - 99.7%) depending on the EMR system used, with SIRs up to 232.9% for breast cancer. Frequently observed errors in routine healthcare data can be classified as: lack of integrity checks, inaccurate use and/or lack of codes, and lack of EMR system functionality. Re-users of coded routine primary care Electronic Medical Record data should be aware that 30% of cancer cases can be missed. Up to 130% of cancer cases found in the EMR data can be false-positive. The type of EMR system and the type of cancer influence the quality of coded diagnosis registry. While data quality can be improved (e.g. through improving system design and by training EMR system users), re-use should only be taken care of by appropriately trained experts. Copyright © 2016. Published by Elsevier B.V.
Veena Kirthika S
Full Text Available Background: Assessment of motor function is a vital characteristic of infant development. Alberta Infant Motor scale (AIMS is considered to be one of the tool available for screening the developmental delays, but this scale was formulated by using western samples. Every country has its own ethnic and cultural background and various differences are observed in the culture and ethnicity. Therefore, there is a need to obtain reliability for the use of AIMS in south Indian population. Purpose: To find the intra-rater and inter-rater reliability of Alberta Infant Motor Scale (AIMS on pre-term infants using the recorded video observations in Indian population. Method: 30 preterm infants in three age groups, 0-3 months (10 infants, 4-7 months (10 infants, 8-18 months (10 infants were recruited for this reliability study. The AIMS was administered to the preterm infants and the performance was videotaped. The performance was then rescored by the same therapist, immediately from the video and on another two consecutive months to estimate intra-rater reliability using ICC (3,1, two-way mixed effects model. For reporting inter-rater reliability, AIMS was scored by three different raters, using ICC (2,k two-way random effects model and by two other therapists to examine the inter and intra-rater reliability. Results: The two-way mixed effects model for intra-rater reliability of AIMS, ICC (3,1 = 0.99 and for reporting inter-rater reliability of AIMS by two-way random effects model, ICC (2,k = 0.96. Conclusion: AIMS has excellent intra and inter-rater reliability using recorded video observations among the preterm infants in India
Bartmanski, Dominik; Woodward, Ian
. This relational process means that both the material affordances and entanglements of vinyl allow us to feel, handle, experience, project, and share its iconicity. The materially mediated meanings of vinyl enabled it to retain currency in independent and collector’s markets and thus resist the planned......In this paper, we use the case of the vinyl record to show that iconic objects become meaningful via a dual process. First, they offer immersive engagements which structure user interpretations through various material experiences of handling, use, and extension. Second, they always work via...
This guide describes record series that pertain to epidemiologic and health-related studies at the Center for Epidemiologic Research (CER) of the Oak Ridge Institute for Science and Education (ORISE). These records document the health and safety monitoring of employees and contract employees of the Department of Energy (DOE) and its predecessor organizations, the Manhattan Engineer District (MED), the Atomic Energy Commission (AEC), and the Energy Research and Development Administration (ERDA). History Associates Incorporated (HAI) prepared this guide as part of DOE's Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI's role in the project, the history of the DOE and its epidemiologic research program, and the history of the Oak Ridge Reservation and the Oak Ridge Institute for Science and Education. It also furnishes information on the procedures that HAI sued to select, inventory, and describe pertinent records; the methodology used to produce the guide; the arrangement of the record series descriptions; the location of the records; and procedures for accessing records repositories
This guide describes record series that pertain to epidemiologic and health-related studies at the Center for Epidemiologic Research (CER) of the Oak Ridge Institute for Science and Education (ORISE). These records document the health and safety monitoring of employees and contract employees of the Department of Energy (DOE) and its predecessor organizations, the Manhattan Engineer District (MED), the Atomic Energy Commission (AEC), and the Energy Research and Development Administration (ERDA). History Associates Incorporated (HAI) prepared this guide as part of DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of the DOE and its epidemiologic research program, and the history of the Oak Ridge Reservation and the Oak Ridge Institute for Science and Education. It also furnishes information on the procedures that HAI sued to select, inventory, and describe pertinent records; the methodology used to produce the guide; the arrangement of the record series descriptions; the location of the records; and procedures for accessing records repositories.
Quinlivan, Julie A; Lyons, Sarah; Petersen, Rodney W
On July 1, 2012 the Australian Government launched the personally controlled electronic health record (PCEHR). This article surveys obstetric patients about their medical record preferences and identifies barriers to adoption of the PCEHR. A survey study was conducted of antenatal patients attending a large Australian metropolitan hospital. Consecutive patients completed questionnaires during the launch phase of the PCEHR system. Quantitative and qualitative data were collected on demographics, computer access and familiarity, preference for medical record system, and perceived benefits and concerns. Of 528 women eligible to participate, 474 completed the survey (89.8%). Respondents had high levels of home access to a computer (90.5%) and the Internet (87.1%) and were familiar with using computers in daily life (median Likert scale of 9 out of 10). Despite this, respondents preferred hospital-held paper records, and only one-third preferred a PCEHR; the remainder preferred patient-held records. Compared with hospital-held paper records, respondents felt a PCEHR would reduce the risk of lost records (padvantages and disadvantages with the PCEHR, although the majority still prefer existing record systems. To increase uptake, confidentiality, privacy, and control concerns need to be addressed.
Thakur, Mridul; Jain, Veena; Parkash, Hari; Kumar, Pravesh
To evaluate and compare the centric relation and horizontal condylar guidance using interocclusal wax and extra oral Gothic arch methods and subjective evaluation of dentures thus fabricated. Centric relation and horizontal condylar guidance was recorded by using interocclusal wax and gothic arch tracing in 28 completely edentulous patients. These records were transferred to the articulator and difference in both values was recorded. After that patients were divided in two groups according to the centric relation and horizontal condylar guidance recording method used to achieve balanced occlusion. Response of the dentures was subjectively evaluated using "Woelfel subjective evaluation criteria". Centric relation recorded by both the methods did coincide in 7.14 % of patients. Centric relation recorded by interocclusal wax was posterior to Gothic centric relation in 21.43 % of patients, and anterior to Gothic centric relation in 71.42 % patients. Gothic arch tracings gave higher mean guidance values on both the sides as compared to protrusive wax record in all the subjects, although the difference was statistically insignificant (P > 0.05). Subjective evaluation showed statistical insignificance for all the parameters in both groups. Gothic arch method records the centric relation at a more posterior position than the Static method, but it does not make any difference in clinical performance of the complete denture. Horizontal condylar guidance angle was approximately similar by both the methods.
Full Text Available The paper presents two case reports of living victims, in which imaging studies of the chest conducted at a medical facility were an essential part of the medico-legal opinion. The first case was that of a young male hospitalized due to CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. The other case was that of a six week old baby hospitalized due to chest X-ray evidence of right hand side rib fractions. The chest X-ray was performed due to one bruise found on the baby’s forehead and two small bruises on the back, which gave rise to suspicions of child abuse. In both cases, expert witnesses in radiology definitively excluded the presence of any fractures. These cases indicate that a new assessment of imaging studies contained in medical records is needed. Expert opinions based solely on the description of imaging studies may result in grave consequences.
http://cern.ch/Record.Club November Selections Just in time for the holiday season, we have added a number of new CDs and DVDs into the Club. You will find the full lists at http://cern.ch/record.club; select the "Discs of the Month" button on the left side on the left panel of the web page and then Nov 2011. New films include the all 5 episodes of Fast and Furious, many of the most famous films starring Jean-Paul Belmondo and those of Louis de Funes and some more recent films such as The Lincoln Lawyer and, according to some critics, Woody Allen’s best film for years – Midnight in Paris. For the younger generation there is Cars 2 and Kung Fu Panda 2. New CDs include the latest releases by Adele, Coldplay and the Red Hot Chili Peppers. We have also added the new Duets II CD featuring Tony Bennett singing with some of today’s pop stars including Lady Gaga, Amy Winehouse and Willy Nelson. The Club is now open every Monday, Wednesday and Friday ...
http://cern.ch/Record.Club June Selections We have put a significant number of new CDs and DVDs into the Club You will find the full lists at http://cern.ch/record.club and select the «Discs of the Month» button on the left side on the left panel of the web page and then June 2011. New films include the latest Action, Suspense and Science Fiction film hits, general drama movies including the Oscar-winning The King’s Speech, comedies including both chapter of Bridget Jones’s Diary, seven films for children and a musical. Other highlights include the latest Harry Potter release and some movies from the past you may have missed including the first in the Terminator series. New CDs include the latest releases by Michel Sardou, Mylene Farmer, Jennifer Lopez, Zucchero and Britney Spears. There is also a hits collection from NRJ. Don’t forget that the Club is now open every Monday, Wednesday and Friday lunchtimes from 12h30 to 13h00 in Restaurant 2, Building 504. (C...
Bonjour a tous, Voici les 24 nouveaux DVD de Juillet disponibles depuis quelques jours, sans oublier les 5 CD Pop musique. Découvrez la saga du terroriste Carlos, la vie de Gainsbourg et les aventures de Lucky Luke; angoissez avec Paranormal Activity et évadez vous sur Pandora dans la peau d’Avatar. Toutes les nouveautés sont à découvrir directement au club. Pour en connaître la liste complète ainsi que le reste de la collection du Record Club, nous vous invitons sur notre site web: http://cern.ch/crc. Toutes les dernières nouveautés sont dans la rubrique « Discs of the Month ». Rappel : le club est ouvert les Lundis, Mercredis, Vendredis de 12h30 à 13h00 au restaurant n°2, bâtiment 504. A bientôt chers Record Clubbers.
http://cern.ch/Record.Club Nouveautés été 2011 Le club de location de CDs et de DVDs vient d’ajouter un grand nombre de disques pour l’été 2011. Parmi eux, Le Discours d’un Roi, oscar 2011 du meilleur film et Harry Potter les reliques de la mort (1re partie). Ce n’est pas moins de 48 DVDs et 10 CDs nouveaux qui vous sont proposés à la location. Il y en a pour tous les genres. Alors n’hésitez pas à consulter notre site http://cern.ch/record.club, voir Disc Catalogue, Discs of the month pour avoir la liste complète. Le club est ouvert tous les Lundi, Mercredi, Vendredi de 12h30 à 13h dans le bâtiment du restaurent N°2 (Cf. URL: http://www.cern.ch/map/building?bno=504) A très bientôt.
Yu, Tzy-Chyi; Zhou, Huanxue
Electronic health records (EHRs) can provide valuable data for outcomes research. However, unlike administrative claims databases, EHRs lack eligibility tables or a standard way to define the benefit coverage period, which could lead to underreporting of healthcare utilization or outcomes, and could result in surveillance bias. We tested the effect of using a proxy eligibility period (eligibility proxy) when estimating a range of health resource utilization and outcomes parameters under varying degrees of missing encounter data. We applied an eligibility proxy to create a benchmark cohort of chronic obstructive pulmonary disease (COPD) patients with 12 months of follow-up, with the assumption of no missing encounter data. The benchmark cohort provided parameter estimates for comparison with 9,000 simulated datasets representing 10-90% of COPD patients (by 10th percentiles) with between 1 and 11 months of continuous missing data. Two analyses, one for datasets using an eligibility proxy and one for those without an eligibility proxy, were performed on the 9,000 datasets to assess estimator performance under increasing levels of missing data. Estimates for each study variable were compared with those from the benchmark dataset, and performance was evaluated using bias, percentage change, and root-mean-square error. The benchmark dataset contained 6,717 COPD patients, whereas the simulated datasets where the eligibility proxy was applied had between 671 and 6,045 patients depending on the percentage of missing data. Parameter estimates had better performance when an eligibility proxy based on the first and last month of observed activity was applied. This finding was consistent across a range of variables representing patient comorbidities, symptoms, outcomes, health resource utilization, and medications, regardless of the measures of performance used. Without the eligibility proxy, all evaluated parameters were consistently underestimated. In a large COPD patient
Robotham, Dan; Evans, Joanne; Watson, Andrew; Perdue, Iain; Craig, Thomas; Rose, Diana; Wykes, Til
Patients can provide consent to have their clinical records linked to a research register, a process known as consent for contact (C4C). There is evidence about how to engage people with mental illness in C4C, but nothing specific to older adults. This is a priority area for research (for example, dementia trials), although sign-up rates to C4C are lower than for younger populations. Through this study we seek to understand these disparities. This was a two-stage cross-sectional observational study. In phase one, focus groups with service users, carers and clinicians informed a framework for clinicians to explain C4C to those on their caseload. In phase two, clinicians explained C4C to 26 service users (and carers where applicable). These conversations were recorded, and their content was analysed. Service users and carers were then interviewed to provide further feedback on their conversations with clinicians. A total of 31 service users, 24 carers and 13 clinical staff took part across the two phases. In phase one, service users and carers sought assurance of the right to refuse participation in further studies (after joining C4C). Clinicians expressed concerns over legal and practical implications of ascertaining mental capacity and best interest. In phase two, clinicians' explanations were less thorough than similar explanations given to younger adults with psychosis. Clinicians omitted details of service users' right to stipulate contact arrangements, which was significantly associated with whether service users/carers agreed to join. Common reasons for joining C4C included altruism and the chance to speak to new people. Few participants refused to join, but reasons included avoidance of stress (potentially alleviated through the presence of a carer). Implementing C4C in older adults' services requires clinicians to deliver concise, simple explanations to individuals and their carers where applicable. Older adults can be suspicious of unsolicited contact; thus
Rajesh, Chelakkal Sukumaran; Sreeroop, Sasidharan Savithrydevi; Pramitha, Vayalamkuzhi; Joseph, Rani; Sreekumar, Krishnapillai; Kartha, Cheranellore Sudha
This article reports a study done on eosin-doped poly(vinyl alcohol)/acrylamide films for holographic recording using 488 nm Ar+ laser. Films were fabricated using gravity settling method at room temperature and were stored under normal laboratory conditions. Ar+ laser (488 nm) was used for fringe recording. Characterization was done by real time transmittance measurement, optical absorption studies, and diffraction efficiency measurements. Various holographic parameters such as exposure energy, recording power, spatial frequency, etc., were optimized so as to ensure maximum performance. More than 85% diffraction efficiency was obtained at an exposure energy of 50 mJ/cm2 in the optimized film. Efforts were taken to study the environmental stability of this self-developing polymeric material by looking at its shelf life and storage life. Compatibility for recording transmission hologram was also checked.
Background Prevalence studies usually depend on self-report of disease status in survey data or administrative data collections and may over- or under-estimate disease prevalence. The establishment of a linked data collection provided an opportunity to explore the accuracy and completeness of capture of information about diabetes in survey and administrative data collections. Methods Baseline questionnaire data at recruitment to the 45 and Up Study was obtained for 266,848 adults aged 45 years and over sampled from New South Wales, Australia in 2006–2009, and linked to administrative data about hospitalisation from the Admitted Patient Data Collection (APDC) for 2000–2009, claims for medical services (MBS) and pharmaceuticals (PBS) from Medicare Australia data for 2004–2009. Diabetes status was determined from response to a question ‘Has a doctor EVER told you that you have diabetes’ (n = 23,981) and augmented by examination of free text fields about diagnosis (n = 119) or use of insulin (n = 58). These data were used to identify the sub-group with type 1 diabetes. We explored the agreement between self-report of diabetes, identification of diabetes diagnostic codes in APDC data, claims for glycosylated haemoglobin (HbA1c) in MBS data, and claims for dispensed medication (oral hyperglycaemic agents and insulin) in PBS data. Results Most participants with diabetes were identified in APDC data if admitted to hospital (79.3%), in MBS data with at least one claim for HbA1c testing (84.7%; 73.4% if 2 tests claimed) or in PBS data through claim for diabetes medication (71.4%). Using these alternate data collections as an imperfect ‘gold standard’ we calculated sensitivities of 83.7% for APDC, 63.9% (80.5% for two tests) for MBS, and 96.6% for PBS data and specificities of 97.7%, 98.4% and 97.1% respectively. The lower sensitivity for HbA1c may reflect the use of this test to screen for diabetes suggesting that it is less useful in identifying
He, Siran; Lunnen, Jeffrey C; Zia, Nukhba; Khan, Uzma; Shamim, Khusro; Hyder, Adnan A
Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning
Full Text Available Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI and waist circumference (WC, and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics.Participants in the RECORD Cohort Study (Paris Region, France, 2007-2008 were surveyed on the supermarket (brand and exact location where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC.Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education, and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC.A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.
Hsieh, Hui-Lung; Kuo, Yu-Ming; Wang, Shiang-Ru; Chuang, Bi-Kun; Tsai, Chung-Hung
The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.
Full Text Available The personal health record (PHR is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT and Unified Theory of Acceptance and Use of Technology (UTAUT model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1 The PMT and UTAUT were effective at predicting PHR usage behaviors; (2 Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3 Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.
Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio
Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.
Ekeland, Anne G; Skipenes, Eva; Nyheim, Beate; Christiansen, Ellen K
The University Hospital of North Norway selected a web-based ulcer record used in Denmark, available from mobile phones. Data was stored in a common database and easily accessible. According to Norwegian legislation, only employees of the organization that owns an IT system can access the system, and use of mobile units requires strong security solutions. The system had to be changed. The paper addresses interactions in order to make the system legal, and assesses regulations that followed. By addressing conflicting scripts and the contingent nature of knowledge, we conducted a formative evaluation aiming at improving the object being studied. Participatory observation in a one year process, minutes from meetings and information from participants, constitute the data material. In the technological domain, one database was replaced by four. In the health care delivery domain, easy access was replaced by a more complicated log on procedure, and in the domain of law and security, a clarification of risk levels was obtained, thereby allowing for access by mobile phones with today's authentication mechanisms. Flexibility concerning predefined scripts was important in all domains. Changes were made that improved the platform for further development of legitimate communication of patient data via mobile units. The study also shows the value of formative evaluations in innovations.
Chaix, Basile; Bean, Kathy; Daniel, Mark; Zenk, Shannon N; Kestens, Yan; Charreire, Hélène; Leal, Cinira; Thomas, Frédérique; Karusisi, Noëlla; Weber, Christiane; Oppert, Jean-Michel; Simon, Chantal; Merlo, Juan; Pannier, Bruno
Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI) and waist circumference (WC), and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics. Participants in the RECORD Cohort Study (Paris Region, France, 2007-2008) were surveyed on the supermarket (brand and exact location) where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC. Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education), and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC. A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.
Hsieh, Hui-Lung; Kuo, Yu-Ming; Wang, Shiang-Ru; Chuang, Bi-Kun; Tsai, Chung-Hung
The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management. PMID:28025557
Mateo, M.-A.; Renom, P.; Romero, J.; Julia, R.; Michener, R.
Information on seagrass paleo-ecology is very scarce because detailed seagrass paleorecords are virtually lacking. The endemic Mediterranean seagrass Posidonia oceanica conjugates two unusual features that allow the reconstruction of the past history of the plant at two different time scales. On the one hand, the study of the leaf sheaths that remain attached to the rhizomes after leaf abcision (lepidochronology), allows to differentiate up to 30 yearly cycles. On the other hand, radiocarbon dating of peat-like deposits derived from Posidonia oceanica rhizomes and roots ('mattes'), reveals a chronological organic record of the plant spanning several thousands of years. Changes in the isotopic signature (δ 13 C) of the sheaths along Posidonia rhizomes from a meadow off Medes Islands (NW Mediterranean, Spain), were highly correlated with changes in annual leave production and with water transparency. These relationships and the isotopic analysis of sheath debris from several Posidonia peats along the Spanish Mediterranean coast are used to make some preliminary inferences about long-term meadow history. Several phenomena potentially making difficult the interpretation of the information contained in Posidonia peats are critically discussed. It is concluded that a detailed study of P. oceanica peats will open new vistas in Mediterranean paleo-ecological and paleo-environmental research (author)
DVD James Bond – Series Complete To all Record Club Members, to start the new year, we have taken advantage of a special offer to add copies of all the James Bond movies to date, from the very first - Dr. No - to the latest - Quantum of Solace. No matter which of the successive 007s you prefer (Sean Connery, George Lazenby, Roger Moore, Timothy Dalton, Pierce Brosnan or Daniel Craig), they are all there. Or perhaps you have a favourite Bond Girl, or even perhaps a favourite villain. Take your pick. You can find the full selection listed on the club web site http://cern.ch/crc; use the panel on the left of the page “Discs of the Month” and select Jan 2010. We remind you that we are open on Mondays, Wednesdays and Fridays from 12:30 to 13:00 in Restaurant 2 (Bldg 504).
Robe, Dominic M.; Boettcher, Stefan; Sibani, Paolo
When quenched rapidly beyond their glass transition, colloidal suspensions fall out of equilibrium. The pace of their dynamics then slows down with the system age, i.e., with the time elapsed after the quench. This breaking of time translational invariance is associated with dynamical observables...... which depend on two time-arguments. The phenomenology is shared by a broad class of aging systems and calls for an equally broad theoretical description. The key idea is that, independent of microscopic details, aging systems progress through rare intermittent structural relaxations that are de......-facto irreversible and become increasingly harder to achieve. Thus, a progression of record-sized dynamical barriers are traversed in the approach to equilibration. Accordingly, the statistics of the events is closely described by a log-Poisson process. Originally developed for relaxation in spin glasses...
Antonella Del Rosso
In the sixties, CERN’s Fellows were but a handful of about 50 young experimentalists present on site to complete their training. Today, their number has increased to a record-breaking 500. They come from many different fields and are spread across CERN’s different activity areas. “Diversifying the Fellowship programme has been the key theme in recent years,” comments James Purvis, Head of the Recruitment, Programmes and Monitoring group in the HR Department. “In particular, the 2005 five-yearly review introduced the notion of ‘senior’ and ‘junior’ Fellowships, broadening the target audience to include those with Bachelor-level qualifications.” Diversification made CERN’s Fellowship programme attractive to a wider audience but the number of Fellows on site could not have increased so much without the support of EU-funded projects, which were instrumental in the growth of the programme. ...
Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen
Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased
Shultz, Susan E.; Tu, Karen
Background Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. Methods We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before–after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians’ monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Results Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Interpretation Implementation of EMRs by
Monge-Nájera, Julián; Nielsen-Muñoz, Vanessa; Azofeifa-Mora, Ana Beatriz
BINABITROP is a bibliographical database of more than 38000 records about the ecosystems and organisms of Costa Rica. In contrast with commercial databases, such as Web of Knowledge and Scopus, which exclude most of the scientific journals published in tropical countries, BINABITROP is a comprehensive record of knowledge on the tropical ecosystems and organisms of Costa Rica. We analyzed its contents in three sites (La Selva, Palo Verde and Las Cruces) and recorded scientific field, taxonomic group and authorship. We found that most records dealt with ecology and systematics, and that most authors published only one article in the study period (1963-2011). Most research was published in four journals: Biotropica, Revista de Biología Tropical/ International Journal of Tropical Biology and Conservation, Zootaxa and Brenesia. This may be the first study of a such a comprehensive database for any case of tropical biology literature.
Full Text Available BINABITROP is a bibliographical database of more than 38 000 records about the ecosystems and organisms of Costa Rica. In contrast with commercial databases, such as Web of Knowledge and Scopus, which exclude most of the scientific journals published in tropical countries, BINABITROP is a comprehensive record of knowledge on the tropical ecosystems and organisms of Costa Rica. We analyzed its contents in three sites (La Selva, Palo Verde and Las Cruces and recorded scientific field, taxonomic group and authorship. We found that most records dealt with ecology and systematics, and that most authors published only one article in the study period (1963-2011. Most research was published in four journals: Biotropica, Revista de Biología Tropical/ International Journal of Tropical Biology and Conservation, Zootaxa and Brenesia. This may be the first study of a such a comprehensive database for any case of tropical biology literature.
Landman, Adam; Emani, Srinivas; Carlile, Narath; Rosenthal, David I; Semakov, Simon; Pallin, Daniel J; Poon, Eric G
Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization's enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization's secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is
Matheson, S L; Kariuki, M; Green, M J; Dean, K; Harris, F; Tzoumakis, S; Tarren-Sweeney, M; Brinkman, S; Chilvers, M; Sprague, T; Carr, V J; Laurens, K R
Childhood maltreatment and a family history of a schizophrenia spectrum disorder (SSD) are each associated with social-emotional dysfunction in childhood. Both are also strong risk factors for adult SSDs, and social-emotional dysfunction in childhood may be an antecedent of these disorders. We used data from a large Australian population cohort to determine the independent and moderating effects of maltreatment and parental SSDs on early childhood social-emotional functioning. The New South Wales Child Development Study combines intergenerational multi-agency data using record linkage methods. Multiple measures of social-emotional functioning (social competency, prosocial/helping behaviour, anxious/fearful behaviour; aggressive behaviour, and hyperactivity/inattention) on 69 116 kindergarten children (age ~5 years) were linked with government records of child maltreatment and parental presentations to health services for SSD. Multivariable analyses investigated the association between maltreatment and social-emotional functioning, adjusting for demographic variables and parental SSD history, in the population sample and in sub-cohorts exposed and not exposed to parental SSD history. We also examined the association of parental SSD history and social-emotional functioning, adjusting for demographic variables and maltreatment. Medium-sized associations were identified between maltreatment and poor social competency, aggressive behaviour and hyperactivity/inattention; small associations were revealed between maltreatment and poor prosocial/helping and anxious/fearful behaviours. These associations did not differ greatly when adjusted for parental SSD, and were greater in magnitude among children with no history of parental SSD. Small associations between parental SSD and poor social-emotional functioning remained after adjusting for demographic variables and maltreatment. Childhood maltreatment and history of parental SSD are associated independently with poor early
Luque, Amneris E; Corales, Roberto; Fowler, Richard J; DiMarco, Jamie; van Keken, Adjuah; Winters, Paul; Keefer, Michael C; Fiscella, Kevin
Persons living with HIV (PLWH) need practical tools to self-manage their condition. We conducted a proof-of-concept study among PLWH to assess whether patients could learn to use a personal health record (PHR) on a hand-held device (iPod Touch) to manage their condition. We began individual trainings and later adapted this to group training. We assessed usability, acceptability and also effects on self-efficacy for treatment adherence using the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Nine PLWH participated in the individual training and 29 participated in the group sessions. The participants were largely middle aged, low-income and of racial/ethnic minorities. The sessions were well attended and participants fully engaged in tasks and shared learning. Most participants stated they intended to use the PHR and reported improved self-efficacy in treatment adherence (P = .05) particularly on the integration of treatment adherence into one's routine (P < .02). Training PLWH in use of a handheld PHR shows promise.
Robins, Jason A; McInnes, Matthew D F; Esmail, Kaisra
Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates' documentation, the heterogeneity therein, as well as its objective data. Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.
Jan Michael Kühn
Full Text Available Translator's Introduction: Jan-Michael Kühn's essay introduces the reader to Hubert Knoblauch's focused ethnography [fokussierte Ethnographie] as an ethnographic fieldwork method. More than a decade after Knoblauch's first publications on this method, there are precious few guides to focused ethnography in the English language, save one (Knoblauch 2005. At any rate, there are certainly no introductions to this methodology that also use EDM scenes as a case study. Kühn's article was originally published in German in Soziologie Magazin, a student-run journal published from Martin Luther University in Halle (Saale but operated by an editorial network that spans Germany. As a result, Kühn orients his writing towards an audience of junior researchers, post-docs and graduate students, highlighting the ways in which focused ethnography suits the circumstances of early research careers, where one may have difficulty securing long-term research stays for fieldwork of broader scope. In particular, he notes that Knoblauch's methods require a very narrow scope for the project (i.e., a "field sector" rather than the whole field, a reliance on the researcher's previous knowledge of the field, and short bursts of intense ethnographic activity in order to create work that is tightly focused but still rigorous and generative of fresh knowledge and new concepts.KEYWORDS: qualitative methods; cultural production; music production; home-recording; technoculture
Ramakrishna, S. S. V. S.; Brahmananda Rao, V.; Srinivasa Rao, B. R.; Hari Prasad, D.; Nanaji Rao, N.; Panda, Roshmitha
The Indian summer monsoon season of 2014 was erratic and ended up with a seasonal rainfall deficit of 12 % and a record drought in June. In this study we analyze the moisture transport characteristics for the monsoon season of 2014 using both NCEP FNL reanalysis (FNL) and CFSv2 (CFS) model data. In FNL, in June 2014 there was a large area of divergence of moisture flux. In other months also there was lesser flux. This probably is the cause of 2014 drought. The CFS model overestimated the drought and it reproduces poorly the observed rainfall over central India (65E–95E; 5N–35N). The correlation coefficient (CC) between the IMD observed rainfall and CFS model rainfall is only 0.1 while the CC between rainfall and moisture flux convergence in CFS model is only 0.20 and with FNL data −0.78. This clearly shows that the CFS model has serious difficulty in reproducing the moisture flux convergence and rainfall. We found that the rainfall variations are strongly related to the moisture convergence or divergence. The hypothesis of Krishnamurti et al. (J Atmos Sci 67:3423–3441, 2010) namely the intrusion of west African desert air and the associated low convective available potential energy inhibiting convection and rainfall shows some promise to explain dry spells in Indian summer monsoon. However, the rainfall or lack of it is mainly explained by convergence or divergence of moisture flux. © 2016 Springer-Verlag Berlin Heidelberg
Tavakoli, Nahid; Jahanbakhsh, Maryam; Shahin, Arash; Mokhtari, Habibollah; Rafiei, Maryam
Today, health information technologies are base of health services and Electronic Medical Record is one of them. The purpose of this paper is to investigate the Technology Acceptance Model (TAM) on EMR at Central Polyclinic Oil Industry that is a pioneer in implementation of EMR in Isfahan. This study was an applied and analytical survey that it was done at the Central Polyclinic Oil Industry. Because statistical population were limited, sampling bas been done by conducting the census and the sample was according to the population. The data was collected by a researcher-made questionnaire that it was validated by experts and its reliability was confirmed by test retest. The questionnaire was developed in 5 scopes including external factors (data quality and user interface), perceived usefulness, perceived ease of usefulness, attitude toward using, and behavioral intention to use. The Results analyzed by SPSS. There was a significant relationship between data quality with PU(r=/295, p/005). The survey of the scopes in the polyclinic showed that there is relationship among user interface, perceived usefulness, perceived ease of usefulness, attitude toward using, and behavioral intention to use, but data quality has no relationship with attitude. It seems the system designers didn't consider to data quality characteristics. It is proposed that they consult with health information management professionals for improvement the existing system.
Borel, Jean-Christian; Pelletier, Julie; Taleux, Nellie; Briault, Amandine; Arnol, Nathalie; Pison, Christophe; Tamisier, Renaud; Timsit, Jean-François; Pepin, Jean-Louis
To assess whether daily variations in three parameters recorded by non-invasive ventilation (NIV) software (respiratory rate (RR), percentage of respiratory cycles triggered by the patient (%Trigg) and NIV daily use) predict the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD) treated by home NIV. Patients completed the EXACT-Pro questionnaire daily to detect exacerbations. The 25th and 75th percentiles of each 24 h NIV parameter were calculated and updated daily. For a given day, when the value of any parameter was >75th or 75th, 'low value' <25th). Stratified conditional logistic regressions estimated the risk of exacerbation when ≥2 days (for RR and %Trigg) or ≥3 days (for NIV use) out of five had an 'abnormal value'. Sixty-four patients were included. Twenty-one exacerbations were detected and medically confirmed. The risk of exacerbation was increased when RR (OR 5.6, 95% CI 1.4 to 22.4) and %Trigg (OR 4.0, 95% CI 1.1 to 14.5) were considered as 'high value' on ≥2 days out of five. This proof-of-concept study shows that daily variations in RR and %Trigg are predictors of an exacerbation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Domaney, Nicholas M; Torous, John; Greenberg, William E
Burnout is a phenomenon with profound negative effects on the US healthcare system. Little is known about the relationship between time spent working on electronic health record (EHR) and burnout among psychiatry residents. The purpose of this study is to generate preliminary data on EHR use and burnout among psychiatry residents and faculty. In August 2017, psychiatry residents and faculty at an academic medical center were given the Maslach Burnout Inventory (MBI), a standardized measurement tool for burnout, and a survey of factors related to EHR use and potential risk factors for burnout. MBI data along with selected burnout risk and protective factors were analyzed with R Studio software. Responses were obtained from 40 psychiatry residents (73%) and 12 clinical faculty members (40%). Residents reported 22 h per week using EHR on average. Mean score of residents surveyed in postgraduate year (PGY)-1-4 met criteria for high emotional exhaustion associated with burnout. The magnitude of correlation between EHR use and emotional exhaustion was stronger than for other burnout factors including sleep, exercise, and clinical service. Psychiatry residents show signs of high emotional exhaustion, which is associated with burnout. Results demonstrate a strong positive correlation between EHR use and resident burnout. Time spent on EHR use may be an area of importance for psychiatry program directors and other psychiatric educators to consider when seeking to minimize burnout and promote wellness.
Jason A. Robins
Full Text Available Background: Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates’ documentation, the heterogeneity therein, as well as its objective data. Methods: Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Results: Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Conclusions: Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.
Martin, Shannon K; Tulla, Kiara; Meltzer, David O; Arora, Vineet M; Farnan, Jeanne M
Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.
Ramakrishna, S. S. V. S.
The Indian summer monsoon season of 2014 was erratic and ended up with a seasonal rainfall deficit of 12 % and a record drought in June. In this study we analyze the moisture transport characteristics for the monsoon season of 2014 using both NCEP FNL reanalysis (FNL) and CFSv2 (CFS) model data. In FNL, in June 2014 there was a large area of divergence of moisture flux. In other months also there was lesser flux. This probably is the cause of 2014 drought. The CFS model overestimated the drought and it reproduces poorly the observed rainfall over central India (65E–95E; 5N–35N). The correlation coefficient (CC) between the IMD observed rainfall and CFS model rainfall is only 0.1 while the CC between rainfall and moisture flux convergence in CFS model is only 0.20 and with FNL data −0.78. This clearly shows that the CFS model has serious difficulty in reproducing the moisture flux convergence and rainfall. We found that the rainfall variations are strongly related to the moisture convergence or divergence. The hypothesis of Krishnamurti et al. (J Atmos Sci 67:3423–3441, 2010) namely the intrusion of west African desert air and the associated low convective available potential energy inhibiting convection and rainfall shows some promise to explain dry spells in Indian summer monsoon. However, the rainfall or lack of it is mainly explained by convergence or divergence of moisture flux. © 2016 Springer-Verlag Berlin Heidelberg
Jiang, Yan-xiu; Bayanheshig; Yang, Shuo; Zhao, Xu-long; Wu, Na; Li, Wen-hao
To making the high resolution grating, a numerical calculation was used to analyze the effect of recording parameters on groove density, focal curve and imaging performance of the grating and their compensation. Based on Fermat' s principle, light path function and aberration, the effect on imaging performance of the grating was analyzed. In the case of fixed using parameters, the error of the recording angle has a greater influence on imaging performance, therefore the gain of the weight of recording angle can improve the accuracy of the recording angle values in the optimization; recording distance has little influence on imaging performance; the relative errors of recording parameters cause the change of imaging performance of the grating; the results indicate that recording parameter errors can be compensated by adjusting its corresponding parameter. The study can give theoretical guidance to the fabrication for high resolution varied-line-space plane holographic grating in on-line spectral diagnostic and reduce the alignment difficulty by analyze the main error effect the imaging performance and propose the compensation method.
Melanie D Logue
Full Text Available Background Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chronically ill older adult has unique circumstances that impact their decision to participate in self-directed care, a theoretical framework to help understand factors that influence the adoption of PHRs is important. Here we describe the results of an exploratory study that provided an initial test of such a framework.Methods The study used a descriptive survey methodology with 38 older adults. The survey questionnaire asked about the personal barriers and facilitators associated with personal health record adoption and included items measuring each of the PHRAM’s four interacting factors (environmental factors, personal factors, technology factors, and self-management, and the resulting behavioural outcome.Results Younger seniors had a more positive attitude toward computers, knew what health resources were available on the internet, agreed that they had the resources in place to use PHRs, and would be more influenced by a family member than a healthcare provider to use them. Conversely, older seniors reported less confidence in their ability to use Internet-based PHRs and did not perceive that they had the resources in place to use them.Conclusions The results of this study indicated that personal, environmental, technology, chronic illness, and behavioral factors operated concurrently as personal barriers and/or facilitators to the adoption of PHRs among the older adult with chronic illness. These factors cannot be isolated because the person commonly
Chaix, Basile; Simon, Chantal; Charreire, Hélène; Thomas, Frédérique; Kestens, Yan; Karusisi, Noëlla; Vallée, Julie; Oppert, Jean-Michel; Weber, Christiane; Pannier, Bruno
Preliminary evidence suggests that recreational walking has different environmental determinants than utilitarian walking. However, previous studies are limited in their assessment of environmental exposures and recreational walking and in the applied modeling strategies. Accounting for individual sociodemographic profiles and weather over the walking assessment period, the study examined whether numerous street network-based neighborhood characteristics related to the sociodemographic, physical, service, social-interactional, and symbolic environments were associated with overall recreational walking and recreational walking in one's residential neighborhood and could explain their spatial distribution. Based on the RECORD Cohort Study (Paris region, France, n=7105, 2007-2008 data), multilevel-spatial regression analyses were conducted to investigate environmental factors associated with recreational walking (evaluated by questionnaire at baseline). A risk score approach was applied to quantify the overall disparities in recreational walking that were predicted by the environmental determinants. Sixty-nine percent of the participants reported recreational walking over the past 7 days. Their mean reported recreational walking time was 3h 31mn. After individual-level adjustment, a higher neighborhood education, a higher density of destinations, green and open spaces of quality, and the absence of exposure to air traffic were associated with higher odds of recreational walking and/or a higher recreational walking time in one's residential neighborhood. As the overall disparities that were predicted by these environmental factors, the odds of reporting recreational walking and the odds of a higher recreational walking time in one's neighborhood were, respectively, 1.59 [95% confidence interval (CI): 1.56, 1.62] times and 1.81 (95% CI: 1.73, 1.87) times higher in the most vs. the least supportive environments (based on the quartiles). Providing green/open spaces of
Ojovan, Silviya M; Rabieh, Noha; Shmoel, Nava; Erez, Hadas; Maydan, Eilon; Cohen, Ariel; Spira, Micha E
The development of multi-electrode array platforms for large scale recording of neurons is at the forefront of neuro-engineering research efforts. Recently we demonstrated, at the proof-of-concept level, a breakthrough neuron-microelectrode interface in which cultured Aplysia neurons tightly engulf gold mushroom-shaped microelectrodes (gMμEs). While maintaining their extracellular position, the gMμEs record synaptic- and action-potentials with characteristic features of intracellular recordings. Here we examined the feasibility of using gMμEs for intracellular recordings from mammalian neurons. To that end we experimentally examined the innate size limits of cultured rat hippocampal neurons to engulf gMμEs and measured the width of the "extracellular" cleft formed between the neurons and the gold surface. Using the experimental results we next analyzed the expected range of gMμEs-neuron electrical coupling coefficients. We estimated that sufficient electrical coupling levels to record attenuated synaptic- and action-potentials can be reached using the gMμE-neuron configuration. The definition of the engulfment limits of the gMμEs caps diameter at ≤2-2.5 μm and the estimated electrical coupling coefficients from the simulations pave the way for rational development and application of the gMμE based concept for in-cell recordings from mammalian neurons.
March Selections By the time this appears, we will have added a number of new CDs and DVDs into the Club. You will find the full lists at http://cern.ch/record.club; select the "Discs of the Month" button on the left panel of the web page and then Mar 2012. New films include recent releases such as Johnny English 2, Bad Teacher, Cowboys vs Aliens, and Super 8. We are also starting to acquire some of the classic films we missed when we initiated the DVD section of the club, such as appeared in a recent Best 100 Films published by a leading UK magazine; this month we have added Spielberg’s Jaws and Scorsese’s Goodfellas. If you have your own ideas on what we are missing, let us know. For children we have no less than 8 Tin-Tin DVDs. And if you like fast moving pop music, try the Beyonce concert DVD. New CDs include the latest releases from Paul McCartney, Rihanna and Amy Winehouse. There is a best of Mylene Farmer, a compilation from the NRJ 201...
Full Text Available INTRODUCTION: Assessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home--work itinerary, and the home--supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops. METHODS: Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops. RESULTS: High individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops. CONCLUSION: This research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than
Full Text Available Abstract Background Swedish studies on antibiotic use in primary care have been based on one-week registrations of infections. In order to study adherence to guidelines, analyses based on large databases that provide information on diagnosis linked prescriptions, are needed. This study describes trends in management of infections in Swedish primary care particularly with regards to antibiotic prescribing and adherence to national guidelines. Methods A descriptive study of Sweden’s largest database regarding diagnosis linked antibiotic prescription data, the Primary care Record of Infections in Sweden (PRIS, for the years 2008, 2010 and 2013. Results Although the consultation rate for all infections remained around 30% each year, antibiotic prescribing rates decreased significantly over the years from 53.7% in 2008, to 45.5% in 2010, to 38.6% in 2013 (p = .032. The antibiotic prescribing rate for respiratory tract infections (RTIs decreased from 40.5% in 2008 to 24.9% in 2013 while those for urinary tract infections and skin and soft tissue infections were unchanged. For most RTI diagnoses there was a decrease in prescription rate from 2008 to 2013, particularly for the age group 0–6 years. Phenoxymethylpenicillin (PcV was the antibiotic most often prescribed, followed by tetracycline. Tonsillitis and acute otitis media were the two RTI diagnoses with the highest number of prescriptions per 1000 patient years (PY. For these diagnoses an increase in adherence to national guidelines was seen, with regards to treatment frequency, choice of antibiotics and use of rapid antigen detection test. The frequency in antibiotic prescribing varied greatly between different Primary Healthcare Centres (PHCCs. Conclusion Falling numbers of consultations and decreased antibiotic prescription rates for RTIs have reduced the antibiotic use in Swedish primary care substantially. Overprescribing of antibiotics could still be suspected due to large variability
Greiver, Michelle; Barnsley, Jan; Aliarzadeh, Babak; Krueger, Paul; Moineddin, Rahim; Butt, Debra A; Dolabchian, Edita; Jaakkimainen, Liisa; Keshavjee, Karim; White, David; Kaplan, David
The quality of electronic medical record (EMR) data is known to be problematic; research on improving these data is needed. The primary objective was to explore the impact of using a data entry clerk to improve data quality in primary care EMRs. The secondary objective was to evaluate the feasibility of implementing this intervention. We used a before and after design for this pilot study. The participants were 13 community based family physicians and four allied health professionals in Toronto, Canada. Using queries programmed by a data manager, a data clerk was tasked with re-entering EMR information as coded or structured data for chronic obstructive pulmonary disease (COPD), smoking, specialist designations and interprofessional encounter headers. We measured data quality before and three to six months after the intervention. We evaluated feasibility by measuring acceptability to clinicians and workload for the clerk. After the intervention, coded COPD entries increased by 38% (P = 0.0001, 95% CI 23 to 51%); identifiable data on smoking categories increased by 27% (P = 0.0001, 95% CI 26 to 29%); referrals with specialist designations increased by 20% (P = 0.0001, 95% CI 16 to 22%); and identifiable interprofessional headers increased by 10% (P = 0.45, 95 CI -3 to 23%). Overall, the intervention was rated as being at least moderately useful and moderately usable. The data entry clerk spent 127 hours restructuring data for 11 729 patients. Utilising a data manager for queries and a data clerk to re-enter data led to improvements in EMR data quality. Clinicians found this approach to be acceptable.
Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline
To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Patel, Vishal N; Kaelber, David C
To demonstrate the use of aggregated and de-identified electronic health record (EHR) data for multivariate post-marketing pharmacosurveillance in a case study of azathioprine (AZA). Using aggregated, standardized, normalized, and de-identified, population-level data from the Explore platform (Explorys, Inc.) we searched over 10 million individuals, of which 14,580 were prescribed AZA based on RxNorm drug orders. Based on logical observation identifiers names and codes (LOINC) and vital sign data, we examined the following side effects: anemia, cell lysis, fever, hepatotoxicity, hypertension, nephrotoxicity, neutropenia, and neutrophilia. Patients prescribed AZA were compared to patients prescribed one of 11 other anti-rheumatologic drugs to determine the relative risk of side effect pairs. Compared to AZA case report trends, hepatotoxicity (marked by elevated transaminases or elevated bilirubin) did not occur as an isolated event more frequently in patients prescribed AZA than other anti-rheumatic agents. While neutropenia occurred in 24% of patients (RR 1.15, 95% CI 1.07-1.23), neutrophilia was also frequent (45%) and increased in patients prescribed AZA (RR 1.28, 95% CI 1.22-1.34). After constructing a pairwise side effect network, neutropenia had no dependencies. A reduced risk of neutropenia was found in patients with co-existing elevations in total bilirubin or liver transaminases, supporting classic clinical knowledge that agranulocytosis is a largely unpredictable phenomenon. Rounding errors propagated in the statistically de-identified datasets for cohorts as small as 40 patients only contributed marginally to the calculated risk. Our work demonstrates that aggregated, standardized, normalized and de-identified population level EHR data can provide both sufficient insight and statistical power to detect potential patterns of medication side effect associations, serving as a multivariate and generalizable approach to post-marketing drug surveillance
Nguyen, Quynh; Bartlett, Gillian; Rodriguez, Charo; Tellier, Pierre-Paul
Personal health records (PHRs) are tools that allow individuals to access, share and manage their health information online. Despite apparent interest, adoption rates remain low. There is a gap in our understanding as to what different populations of users, in particular young adults, might want from such a tool. To describe and interpret the views and expectations of young healthy adults about using an online PHR. A qualitative descriptive study was carried out. Four focus groups were conducted with a total of 29 participants (18-34 years old) from a community setting in Montreal, Canada. Interviews were transcribed and analyzed with inductivethematic analysis. With respect to how young adults viewed PHRs, three broad themes were identified: perceived advantages to using a PHR, future PHR users and concerns about PHRs. Three other overarching themes emerged from data analysis in terms of what participants expected from using a PHR: the use of the PHR for preventative health, PHR support to take more control over their health and strategies to make the PHR worthwhile. A conceptual framework of factors influencing expectations of PHR use in this population is proposed. While young adults view the PHR as beneficial, this is not enough for them to be motivated to actually use a PHR. To foster use, the PHRs need to be perceived as a health prevention tool that helps users to increase control over theirhealth status. More research is needed to understand the expectations and anticipated use of different populations in designing a person-centered tool;the proposedframework provides theoretical basis in this regard.
Emerson, E; Brigham, P
Research on child development in general has highlighted the importance that the family environment plays in mediating the pathway between exposure to low socio-economic position (SEP) and child well-being. While child developmental models in intellectual disability have highlighted the interplay between social context, family environment and child development, little empirical work has attempted to formally evaluate the evidence in support of specific mediating pathways between low SEP and child outcomes. Secondary analysis of cross-sectional confidentialized needs analysis data collected in three Primary Care Trusts in England covering a total population of 1.25 million people. Case record reviews were undertaken for 46 023 households, 2236 (4.9%) of which contained a child in the target age range with developmental delay. Children with developmental delay, when compared with their non-disabled peers, were at significantly increased risk of poorer health outcomes and of being exposed to a wide range of social determinants of poor health. Controlling for between-group differences in exposure to social determinants of poor health reduced the risk of developmental delay being associated with poorer health outcomes by 45% for behaviour problems and 89% for risk of significant harm. For children with developmental delay, parenting difficulties appears to play a particularly significant role in partially mediating the effects of low SEP. The findings of the present study point to the potential effectiveness of family-focused early intervention to prevent the emergence and escalation of behavioural difficulties and health problems in children with developmental delay. © 2014 John Wiley & Sons Ltd.
Ratanawongsa, Neda; Matta, George Y; Bohsali, Fuad B; Chisolm, Margaret S
Clinicians' use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians' EHR workload, stress, and burnout. We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with "misses" (errors that were not caught at the time) or "near misses" (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about "misses we don't even know about." Risk factors included the computer's position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR
Gross, Anne H; Leib, Ryan K; Tonachel, Anne; Tonachel, Richard; Bowers, Danielle M; Burnard, Rachel A; Rhinehart, Catherine A; Valentim, Rahila; Bunnell, Craig A
This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.
Micòl E Gianinazzi
Full Text Available The abstraction of data from medical records is a widespread practice in epidemiological research. However, studies using this means of data collection rarely report reliability. Within the Transition after Childhood Cancer Study (TaCC which is based on a medical record abstraction, we conducted a second independent abstraction of data with the aim to assess a intra-rater reliability of one rater at two time points; b the possible learning effects between these two time points compared to a gold-standard; and c inter-rater reliability.Within the TaCC study we conducted a systematic medical record abstraction in the 9 Swiss clinics with pediatric oncology wards. In a second phase we selected a subsample of medical records in 3 clinics to conduct a second independent abstraction. We then assessed intra-rater reliability at two time points, the learning effect over time (comparing each rater at two time-points with a gold-standard and the inter-rater reliability of a selected number of variables. We calculated percentage agreement and Cohen's kappa.For the assessment of the intra-rater reliability we included 154 records (80 for rater 1; 74 for rater 2. For the inter-rater reliability we could include 70 records. Intra-rater reliability was substantial to excellent (Cohen's kappa 0-6-0.8 with an observed percentage agreement of 75%-95%. In all variables learning effects were observed. Inter-rater reliability was substantial to excellent (Cohen's kappa 0.70-0.83 with high agreement ranging from 86% to 100%.Our study showed that data abstracted from medical records are reliable. Investigating intra-rater and inter-rater reliability can give confidence to draw conclusions from the abstracted data and increase data quality by minimizing systematic errors.
Liu Xiaodong; Jiang Shan; Zhang Pengfei; Xu Liqiang
Historical changes of anthropogenic Pb pollution were reconstructed based on Pb concentrations and isotope ratios in lake and peat sediment profiles from Ny-Ålesund of Arctic. The calculated excess Pb isotope ratios showed that Pb pollution largely came from west Europe and Russia. The peat profile clearly reflected the historical changes of atmospheric deposition of anthropogenic Pb into Ny-Ålesund, and the result showed that anthropogenic Pb peaked at 1960s–1970s, and thereafter a significant recovery was observed by a rapid increase of 206 Pb/ 207 Pb ratios and a remarkable decrease in anthropogenic Pb contents. In contrast to the peat record, the longer lake record showed relatively high anthropogenic Pb contents and a persistent decrease of 206 Pb/ 207 Pb ratios within the uppermost samples, suggesting that climate-sensitive processes such as catchment erosion and meltwater runoff might have influenced the recent change of Pb pollution record in the High Arctic lake sediments. - Highlights: ► Historical changes of anthropogenic Pb pollution in Ny-Ålesund were reconstructed. ► Anthropogenic Pb in Ny-Ålesund was largely originated from W. European and Russia. ► Anthropogenic Pb recorded in peat sediments peaked at 1960–1970s and then declined. ► High anthropogenic fluxes were found in recent change of Pb record from lake sediments. ► Climate-sensitive processes might have influenced recent Pb accumulation rate in lakes. - This manuscript reports the effects of climate-sensitive processes on historical records of Pb pollution in sediments of Arctic lakes.
Leibson, Cynthia L.; Brown, Allen W.; Ransom, Jeanine E.; Diehl, Nancy N.; Perkins, Patricia K.; Mandrekar, Jay; Malec, James F.
Background Extremely few objective estimates of traumatic brain injury incidence include all ages, both sexes, all injury mechanisms, and the full spectrum from very mild to fatal events. Methods We used unique Rochester Epidemiology Project medical records-linkage resources, including highly sensitive and specific diagnostic coding, to identify all Olmsted County, MN, residents with diagnoses suggestive of traumatic brain injury regardless of age, setting, insurance, or injury mechanism. Provider-linked medical records for a 16% random sample were reviewed for confirmation as definite, probable, possible (symptomatic), or no traumatic brain injury. We estimated incidence per 100,000 person-years for 1987–2000 and compared these record-review rates with rates obtained using Centers for Disease Control and Prevention (CDC) data-systems approach. For the latter, we identified all Olmsted County residents with any CDC-specified diagnosis codes recorded on hospital/emergency department administrative claims or death certificates 1987–2000. Results Of sampled individuals, 1257 met record-review criteria for incident traumatic brain injury; 56% were ages 16–64 years, 56% were male, 53% were symptomatic. Mechanism, sex, and diagnostic certainty differed by age. The incidence rate per 100,000 person-years was 558 (95% confidence interval = 528–590) versus 341 (331–350) using the CDC data system approach. The CDC approach captured only 40% of record-review cases. Seventy-four percent of missing cases presented to hospital/emergency department; none had CDC-specified codes assigned on hospital/emergency department administrative claims or death certificates; 66% were symptomatic. Conclusions Capture of symptomatic traumatic brain injuries requires a wider range of diagnosis codes, plus sampling strategies to avoid high rates of false-positive events. PMID:21968774
Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.
Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas
To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its
Full Text Available Abstract Background There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised. Methods Guided by Dobrow et al.'s (2004 conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review
Sayers, Adrian; Ben-Shlomo, Yoav; Blom, Ashley W; Steele, Fiona
Studies involving the use of probabilistic record linkage are becoming increasingly common. However, the methods underpinning probabilistic record linkage are not widely taught or understood, and therefore these studies can appear to be a 'black box' research tool. In this article, we aim to describe the process of probabilistic record linkage through a simple exemplar. We first introduce the concept of deterministic linkage and contrast this with probabilistic linkage. We illustrate each step of the process using a simple exemplar and describe the data structure required to perform a probabilistic linkage. We describe the process of calculating and interpreting matched weights and how to convert matched weights into posterior probabilities of a match using Bayes theorem. We conclude this article with a brief discussion of some of the computational demands of record linkage, how you might assess the quality of your linkage algorithm, and how epidemiologists can maximize the value of their record-linked research using robust record linkage methods. © The Author 2015; Published by Oxford University Press on behalf of the International Epidemiological Association.
Mooij, Rob; Lugumila, Joseph; Mwashambwa, Masumbuko Y.; Mwampagatwa, Ipyana H.; van Dillen, Jeroen; Stekelenburg, Jelle
Background: Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed
Gho, Johannes M.I.H.; Schmidt, Amand F.; Pasea, Laura; Koudstaal, Stefan; Pujades-Rodriguez, Mar; Denaxas, Spiros; Shah, Anoop D.; Patel, Riyaz S.; Gale, Chris P.; Hoes, Arno W.; Cleland, John G.; Hemingway, Harry; Asselbergs, Folkert W.
Objectives: To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs). Methods: Data were used from the CALIBER
Richards, Rhonda J.
Government initiatives called for electronic health records for each individual healthcare consumer by 2014. The purpose of the initiatives is to provide for the common exchange of clinical information between healthcare consumers, healthcare providers, third-party payers and public healthcare officials. This exchange of healthcare information…
J.P. Velema (Johan)
textabstractSince the introduction of the string galvanometer by Einthoven (1901), various instruments have been developed (a technical review is given by Dunn & Rahm, 1950) to record the so-called electrocardiogram (ECG). Physical activity, changes in position and certain bodily functions such as
densirostris) off the coast of El Hierro in the Canary Islands. A tag was deployed with relative ease on an adult beaked whale which proceeded to carry it for...located off-shore of El Hierro by chance. On examination, we found that water ingress had again caused failure of the recording circuit early in the
El Aarbaoui, Tarik; Méline, Julie; Brondeel, Ruben; Chaix, Basile
Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying short-term mechanisms remain uncertain. To explore the concomitant and lagged short-term associations between personal exposure to noise and heart rate variability (HRV) in a real life setting in the Île-de-France region. The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate data for 75 participants, aged 34-74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography (ECG) sensor on the chest. HRV parameters and noise levels were calculated for 5-min windows. Short-term relationships between noise level and log-transformed HRV parameters were assessed using mixed effects models with a random intercept for participants and a temporal autocorrelation structure, adjusted for heart rate, physical activity (accelerometry), and short-term trends. An increase by one dB(A) of A-weighted equivalent sound pressure level (Leq) was associated with a 0.97% concomitant increase of the Standard deviation of normal to normal intervals (SDNN) (95% CI: 0.92, 1.02), of 2.08% of the Low frequency band power (LF) (95% CI: 1.97, 2.18), of 1.30% of the High frequency band power (HF) (95% CI: 1.17, 1.43), and of 1.16% of the LF/HF ratio (95% CI: 1.10, 1.23). The analysis of lagged exposures to noise adjusted for the concomitant exposure illustrates the dynamic of recovery of the autonomic nervous system. Non-linear associations were documented with all HRV parameters with the exception of HF. Piecewise regression revealed that the association was almost 6 times stronger below than above 65 Leq dB(A) for the SDNN and LF/HF ratio. Personal noise exposure was found to be related to a concomitant increase of the overall HRV, with evidence of imbalance of the autonomic nervous system towards sympathetic activity, a pathway to increased cardiovascular morbidity and mortality. Copyright © 2017 Elsevier Ltd
McInnes D Keith
Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising
Triebwasser, Corey; Wang, Rong; DeWan, Andrew T; Metayer, Catherine; Morimoto, Libby; Wiemels, Joseph L; Kadan-Lottick, Nina; Ma, Xiaomei
To evaluate the relationship between birth weight (along with a variety of pre and perinatal characteristics) and the risk of paediatric Hodgkin lymphoma (HL) diagnosed at age birth records from 1978-2009 and cancer diagnosis data from 1988-2011 to conduct a population-based case-control study with 1216 cases and 4485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of paediatric HL overall and by age of diagnosis, controlling for other perinatal factors. Compared to children with a normal birth weight (2500-3999 g), those who had a high birth weight (≥4000 g) had an increased risk of paediatric HL overall (OR = 1.23, 95% CI: 1.02-1.48) after adjusting for birth order, maternal age at the time of delivery, and paternal age at the time of delivery. The magnitude of association appeared larger for subgroups of children whose age of diagnosis was 0-10 years (OR = 1.56, 95% CI: 1.04-2.24) or 15-19 years (OR = 1.43, 95% CI: 1.11-1.83), while no association was observed in 11-14 year olds. Compared with firstborn children, those who were third or higher in birth order had a reduced risk of paediatric HL overall (OR = 0.80, 95% CI: 0.67-0.95), and this association also varied by age of diagnosis. In this study with the largest number of paediatric HL cases, high birth weight was associated with an increased disease risk for most but not all ages of diagnosis. The different findings by age of diagnosis regarding both birth weight and birth order underscore the importance to stratify paediatric HL by age at diagnosis in future etiological investigations. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Hoogenboom, Wouter S.; Perlis, Roy H.; Smoller, Jordan W.; Zeng-Treitler, Qing; Gainer, Vivian S.; Murphy, Shawn N.; Churchill, Susanne E.; Kohane, Isaac S.; Shenton, Martha E.; Iosifescu, Dan V.
For certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six non-remitters), and fifteen healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied. PMID:23149041
Firth, Clair L; Käsbohrer, Annemarie; Schleicher, Corina; Fuchs, Klemens; Egger-Danner, Christa; Mayerhofer, Martin; Schobesberger, Hermann; Köfer, Josef; Obritzhauser, Walter
Antimicrobial use in livestock production is an important contemporary issue, which is of public interest worldwide. Antimicrobials are not freely available to Austrian farmers and can only be administered to livestock by veterinarians, or by farmers who are trained members of the Animal Health Service. Since 2015, veterinarians have been required by law to report antimicrobials dispensed to farmers for use in food-producing animals. The study presented here went further than the statutory framework, and collected data on antimicrobials dispensed to farmers and those administered by veterinarians. Seventeen veterinary practices were enrolled in the study via convenience sampling. These veterinarians were asked to contact interested dairy farmers regarding participation in the study (respondent-driven sampling). Data were collected from veterinary practice software between 1st October 2015 and 30th September 2016. Electronic data (89.4%) were transferred via an online interface and paper records (10.6%) were entered by the authors. Antimicrobial treatments with respect to udder disease were analysed by number of defined daily doses per cow and year (nDDD vet /cow/year), based on the European Medicines Agency technical unit, Defined Daily Dose for animals (DDD vet ). Descriptive statistics and the Wilcoxon rank sum test were used to analyse the results. Antimicrobial use data from a total of 248 dairy farms were collected during the study, 232 of these farms treated cows with antibiotics; dry cow therapy was excluded from the current analysis. The mean number of DDD vet /cow/year for the antimicrobial treatment of all udder disease was 1.33 DDD vet /cow/year. Of these treatments, 0.73 DDD vet /cow/year were classed as highest priority critically important antimicrobials (HPCIAs), according to the World Health Organization (WHO) definition. The Wilcoxon rank sum test determined a statistically significant difference between the median number of DDD vet /cow/year for
Clair L. Firth
Full Text Available Background Antimicrobial use in livestock production is an important contemporary issue, which is of public interest worldwide. Antimicrobials are not freely available to Austrian farmers and can only be administered to livestock by veterinarians, or by farmers who are trained members of the Animal Health Service. Since 2015, veterinarians have been required by law to report antimicrobials dispensed to farmers for use in food-producing animals. The study presented here went further than the statutory framework, and collected data on antimicrobials dispensed to farmers and those administered by veterinarians. Methods Seventeen veterinary practices were enrolled in the study via convenience sampling. These veterinarians were asked to contact interested dairy farmers regarding participation in the study (respondent-driven sampling. Data were collected from veterinary practice software between 1st October 2015 and 30th September 2016. Electronic data (89.4% were transferred via an online interface and paper records (10.6% were entered by the authors. Antimicrobial treatments with respect to udder disease were analysed by number of defined daily doses per cow and year (nDDDvet/cow/year, based on the European Medicines Agency technical unit, Defined Daily Dose for animals (DDDvet. Descriptive statistics and the Wilcoxon rank sum test were used to analyse the results. Results Antimicrobial use data from a total of 248 dairy farms were collected during the study, 232 of these farms treated cows with antibiotics; dry cow therapy was excluded from the current analysis. The mean number of DDDvet/cow/year for the antimicrobial treatment of all udder disease was 1.33 DDDvet/cow/year. Of these treatments, 0.73 DDDvet/cow/year were classed as highest priority critically important antimicrobials (HPCIAs, according to the World Health Organization (WHO definition. The Wilcoxon rank sum test determined a statistically significant difference between the median
Brázdil, R.; Chromá, K.; Řezníčková, L.; Valášek, H.; Dolák, L.; Stachoň, Z.; Soukalová, E.; Dobrovolný, P.
Since the second half of the 17th century, tax relief has been available to farmers and landowners to offset flood damage to property (buildings) and land (fields, meadows, pastures, gardens) in South Moravia, Czech Republic. Historically, the written applications for this were supported by a relatively efficient bureaucratic process that left a clear data trail of documentation, preserved at several levels: in the communities affected, in regional offices, and in the Moravian Land Office, all of which are to be found in estate and family collections in the Moravian Land Archives in the city of Brno, the provincial capital. As well as detailed information about damage done and administrative responses to it, data is often preserved as to the flood event itself, the time of its occurrence and its impacts, sometimes together with causes and stages. The final flood database based on taxation records is used here to describe the temporal and spatial density of both flood events and the records themselves. The information derived is used to help create long-term flood chronologies for the Rivers Dyje, Jihlava, Svratka and Morava, combining floods interpreted from taxation records with other documentary data and floods derived from later systematic hydrological measurements (water levels, discharges). Common periods of higher flood frequency appear largely in 1821-1850 and 1921-1950, although this shifts to several other decades for individual rivers. Certain uncertainties are inseparable from flood data taxation records: their spatial and temporal incompleteness; the inevitable limitation to larger-scale damage and to the summer half-year; and the different characters of rivers, including land-use changes and channel modifications. Taxation data has great potential for extending our knowledge of past floods for the rest of the Czech Republic as well, not to mention other European countries in which records have survived.
The magnetic storage areal density keeps increasing every year, and magnetic recording-based hard disk drives provide a very cheap and effective solution to the ever increasing demand for data storage. Heat assisted magnetic recording (HAMR) and bit patterned media have been proposed to increase the magnetic storage density beyond 1 Tb/in2. In HAMR systems, high magnetic anisotropy materials are recommended to break the superparamagnetic limit for further scaling down the size of magnetic bits. However, the current magnetic transducers are not able to generate strong enough field to switch the magnetic orientations of the high magnetic anisotropy material so the data writing is not able to be achieved. So thermal heating has to be applied to reduce the coercivity for the magnetic writing. To provide the heating, a laser is focused using a near field transducer (NFT) to locally heat a ~(25 nm)2 spot on the magnetic disk to the Curie temperature, which is ~ 400 C-600°C, to assist in the data writing process. But this high temperature working condition is a great challenge for the traditional head-disk interface (HDI). The disk lubricant can be depleted by evaporation or decomposition. The protective carbon overcoat can be graphitized or oxidized. The surface quality, such as its roughness, can be changed as well. The NFT structure is also vulnerable to degradation under the large number of thermal load cycles. The changes of the HDI under the thermal conditions could significantly reduce the robustness and reliability of the HAMR products. In bit patterned media systems, instead of using the continuous magnetic granular material, physically isolated magnetic islands are used to store data. The size of the magnetic islands should be about or less than 25 nm in order to achieve the storage areal density beyond 1 Tb/in2. However, the manufacture of the patterned media disks is a great challenge for the current optical lithography technology. Alternative lithography
Gómez-González, J F; Destexhe, A; Bal, T
Electrophysiological recordings of single neurons in brain tissues are very common in neuroscience. Glass microelectrodes filled with an electrolyte are used to impale the cell membrane in order to record the membrane potential or to inject current. Their high resistance induces a high voltage drop when passing current and it is essential to correct the voltage measurements. In particular, for voltage clamping, the traditional alternatives are two-electrode voltage-clamp technique or discontinuous single electrode voltage-clamp (dSEVC). Nevertheless, it is generally difficult to impale two electrodes in a same neuron and the switching frequency is limited to low frequencies in the case of dSEVC. We present a novel fully computer-implemented alternative to perform continuous voltage-clamp recordings with a single sharp-electrode. To reach such voltage-clamp recordings, we combine an active electrode compensation algorithm (AEC) with a digital controller (AECVC). We applied two types of control-systems: a linear controller (proportional plus integrative controller) and a model-based controller (optimal control). We compared the performance of the two methods to dSEVC using a dynamic model cell and experiments in brain slices. The AECVC method provides an entirely digital method to perform continuous recording and smooth switching between voltage-clamp, current clamp or dynamic-clamp configurations without introducing artifacts.
Full Text Available This study examined the influence of resettlement of the capital of Probolinggo Regency toward service quality of Police Record (SKCK in Probolinggo Resort Police. Probolinggo Resort Police (Polres is one government agencies that experiencing resettlement of the location from Probolinggo City to Kraksaan district. It is expected that by this resettlement, public service processes would become ‘better and in high quality’. The study used quantitative research method with explanatory approach to test the hypothesis that has been set. Dependent variable in this study are resettlement of the capital of regency (X with the variables: affordability, recoverability and replicability. While the dependent variable in this study are the service quality of Police Record (SKCK (Y with the indicators: tangibles, reliability, responsiveness, assurance and empathy. The study used multiple linear regression method of analysis. The study revealed that the resettlement of the capital of regency variable (X which consist of three variables such as affordability (X1, recoverability (X2 and replicability variable (X3 influence significantly toward service quality of the Police Record (SKCK in Probolinggo Resort Police (Polres. Keywords: The Resettlement, The Capital of Regency, Service Quality, Police Record (SKCK, Probolinggo Resort Police.
Full Text Available Spiking models can accurately predict the spike trains produced by cortical neurons in response to somatically injected currents. Since the specific characteristics of the model depend on the neuron, a computational method is required to fit models to electrophysiological recordings. The fitting procedure can be very time consuming both in terms of computer simulations and in terms of code writing. We present algorithms to fit spiking models to electrophysiological data (time-varying input and spike trains that can run in parallel on graphics processing units (GPUs. The model fitting library is interfaced with Brian, a neural network simulator in Python. If a GPU is present it uses just-in-time compilation to translate model equations into optimized code. Arbitrary models can then be defined at script level and run on the graphics card. This tool can be used to obtain empirically validated spiking models of neurons in various systems. We demonstrate its use on public data from the INCF Quantitative Single-Neuron Modeling 2009 competition by comparing the performance of a number of neuron spiking models.
This document consists of viewgraphs from the presentations at the conference. Topics included are: DOE records management overview, NIRMA and ARMA resources, NARA records management training, potential quality assurance records, filing systems, organizing and indexing technical records, DOE-HQ initiatives, IRM reviews, status of epidemiologic inventory, disposition of records and personal papers, inactive records storage, establishing administrative records, managing records at Hanford, electronic mail -- legal and records issues, NARA-GAO reports status, consultive selling, automated indexing, decentralized approach to scheduling at a DOE office, developing specific records management programs, storage and retrieval at Savannah River Plant, an optical disk case study, and special interest group reports.
Liu, Xiaodong; Jiang, Shan; Zhang, Pengfei; Xu, Liqiang
Historical changes of anthropogenic Pb pollution were reconstructed based on Pb concentrations and isotope ratios in lake and peat sediment profiles from Ny-Ålesund of Arctic. The calculated excess Pb isotope ratios showed that Pb pollution largely came from west Europe and Russia. The peat profile clearly reflected the historical changes of atmospheric deposition of anthropogenic Pb into Ny-Ålesund, and the result showed that anthropogenic Pb peaked at 1960s-1970s, and thereafter a significant recovery was observed by a rapid increase of (206)Pb/(207)Pb ratios and a remarkable decrease in anthropogenic Pb contents. In contrast to the peat record, the longer lake record showed relatively high anthropogenic Pb contents and a persistent decrease of (206)Pb/(207)Pb ratios within the uppermost samples, suggesting that climate-sensitive processes such as catchment erosion and meltwater runoff might have influenced the recent change of Pb pollution record in the High Arctic lake sediments. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Zhao, Min; Cooney, Marie Therese; Klipstein-Grobusch, Kerstin; Vaartjes, Ilonca; De Bacquer, Dirk; De Sutter, Johan; Reiner, Željko; Prescott, Eva; Faggiano, Pompilio; Vanuzzo, Diego; AlFaleh, Hussam; Menown, Ian Ba; Gait, Dan; Posogova, Nana; Sheu, Wayne H-H; Zhao, Dong; Zuo, Huijuan; Grobbee, Diederick E; Graham, Ian M
To simplify the assessment of the recording and control of coronary heart disease risk factors in different countries and regions. The SUrvey of Risk Factors (SURF) is an international clinical audit. Data on consecutive patients with established coronary heart disease from countries in Europe, Asia and the Middle East were collected on a one-page collection sheet or electronically during routine clinic visits. Information on demographics, diagnostic category, risk factors, physical and laboratory measurements, and medications were included and key variables summarized in a Cardiovascular Health Index Score. Coronary heart disease patients (N = 10,186; 29% women) were enrolled from 79 centres in 11 countries. Recording of risk factors varied considerably: smoking was recorded in over 98% of subjects, while about 20% lacked data on laboratory measurements relevant to cardiovascular disease risk. Sixteen per cent of participants reported smoking, 29% were obese, and 46% had abdominal obesity. Sixty per cent of participants had blood pressure control of risk factors with substantial variation between countries, calling for development and implementation of clinical standards of secondary prevention of coronary heart disease. © The European Society of Cardiology 2016.
The capacity of dentate subjects to discriminate the thickness of objects placed between the teeth seems to depend on receptors in the periodontal ligament and muscles. The compensatory mechanism of ankylotic implants for the function of missing periodontal ligaments is not yet known. To investigate this question in overdenture wearers, 26 patients with ITI implants and 20 patients with natural roots were selected. According to the experimental protocol, the discriminatory ability was recorded with 10 steel foils (thickness ranging from 10 to 100 microns) placed between the premolars. Each thickness was tested 10 times and the test subjects were required to distinguish whether foil was positioned between the teeth. A maximum of 100 correct or 100 incorrect answers was possible. The average number of incorrect answers was significantly higher in test subjects with implants. The 50% limit (ie, the tested thickness recorded with at least 5 wrong answers) was established, but no statistically significant difference was found. In both groups, the critical tactile threshold of perceived thickness was 30 to 40 microns, with 2 being the average number of incorrect assessments. When comparing the minimal thickness, which was recorded without incorrect assessment, a significantly lower threshold was observed on patients with natural roots. Thus, active tactile sensibility appears to depend on the receptors in the periodontal ligament. However, wearing of removable prostheses is a modifying factor and may influence the oral tactile sensibility for both groups.
Unbeck, Maria; Schildmeijer, Kristina; Henriksson, Peter; Jürgensen, Urban; Muren, Olav; Nilsson, Lena; Pukk Härenstam, Karin
There has been a theoretical debate as to which retrospective record review method is the most valid, reliable, cost efficient and feasible for detecting adverse events. The aim of the present study was to evaluate the feasibility and capability of two common retrospective record review methods, the "Harvard Medical Practice Study" method and the "Global Trigger Tool" in detecting adverse events in adult orthopaedic inpatients. We performed a three-stage structured retrospective record review process in a random sample of 350 orthopaedic admissions during 2009 at a Swedish university hospital. Two teams comprised each of a registered nurse and two physicians were assigned, one to each method. All records were primarily reviewed by registered nurses. Records containing a potential adverse event were forwarded to physicians for review in stage 2. Physicians made an independent review regarding, for example, healthcare causation, preventability and severity. In the third review stage all adverse events that were found with the two methods together were compared and all discrepancies after review stage 2 were analysed. Events that had not been identified by one of the methods in the first two review stages were reviewed by the respective physicians. Altogether, 160 different adverse events were identified in 105 (30.0%) of the 350 records with both methods combined. The "Harvard Medical Practice Study" method identified 155 of the 160 (96.9%, 95% CI: 92.9-99.0) adverse events in 104 (29.7%) records compared with 137 (85.6%, 95% CI: 79.2-90.7) adverse events in 98 (28.0%) records using the "Global Trigger Tool". Adverse events "causing harm without permanent disability" accounted for most of the observed difference. The overall positive predictive value for criteria and triggers using the "Harvard Medical Practice Study" method and the "Global Trigger Tool" was 40.3% and 30.4%, respectively. More adverse events were identified using the "Harvard Medical Practice Study
Office of Personnel Management — The Office of Personnel Management (OPM) Records Management Directive provides guidelines for the management of OPM records, and identifies the records management...
Full Text Available The purpose of this study is to understand which bibliographic data are the core elements of the user’s queries? What users’ viewpoints about resource descriptions using different metadata standards? What kinds of value-added items are the users’ favorite when they conduct a bibliographic search? What are users’ viewpoints about bibliographic records integrated with the Digital Archival and Institutional Repository resources through metadata interoperability methods? This research adopted experiments, observation and interviews. The sample subjects are drawn from 14 students of The Graduate Institute of Library and Information Science and College of Agriculture and Natural Resources. First of all, the researcher displayed the bibliographic records using original MARC from the library. Secondly, users compared the images of OPAC from the library with the format of DC and MODS transformed through the MarcEdit software. Additionally, the researcher conducted interviews to understand users’ viewpoints about using three metadata schemas to describe the same book. Finally, the researcher asked the degree of users’ satisfaction about using bibliographic records alone and bibliographic records integrated with the Digital Archival and Institutional Repository resources. The findings suggest that libraries could provide more value-added and comprehensive services of bibliographic records and information retrieval, in order for all kinds of resources to be fully utilized, which helps to meet the users’ information needs.
Janssen, Evelien H. C.; van de Ven, Peter M.; Terluin, Berend; Verhaak, Peter F. M.; van Marwijk, Harm W. J.; Smolders, Mirrian; van der Meer, Klaas; Penninx, Brenda W. J. H.; van Hout, Hein P. J.
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Results: The results showed statistically significant difference between the condylar guidance values obtained from Orthopantomograph (Radiograph and the condylar guidance values obtained at the stage of jaw relation. Conclusion: Within the limitations of the study, it can be concluded that the condylar guidance values obtained from the Radiographs were higher than those obtained at the stage of jaw relation recording stage.
Janssen, E.H.C.; Ven, P.M. van de; Terluin, B.; Verhaak, P.F.M.; Marwijk, H.W.J. van; Smolders, M.; Meer, K. van der; Penninx, B.W.J.H.; Hout, H.P.J. van
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Clerkin, P; Buckley, B S; Murphy, A W; MacFarlane, A E
National policies are being developed, which may limit access to patients' records for health research. This could reduce the ability of health research to benefit society as a whole. It is important to develop an in-depth understanding of people's views across demographic groups to inform such policy development. Aims. To explore patients' views about the use of their general practice records in health research with attention to gender and age. Design of study. Qualitative study using focus groups. Six General Practices in the west of Ireland. Focus Group interviews with 35 people who were patients at the practices. Overall, participants were positively inclined towards the idea of information from their records (anonymous and identifiable) being used in research for the 'greater good' although there were some concerns about personal information being 'leaked'. Males emphasized risks in relation to employment and finances, whereas females emphasized risks in relation to social discomfort and embarrassment. Participants were supportive of consent models that enable patients to give prior ongoing consent for specific agreed 'levels' of data use, affording patients self-determination without the need for consent request on study-by-study basis. Overall male and female patients of different ages are supportive of the use of their general practice records in health research and of general practitioners as data protectors.
The first workshop of the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT) was held on 4 October 2004. The workshop was hosted by the Japan Nuclear Energy Safety (JNES) Organization. The BFBT Benchmark is sponsored by the US Nuclear Regulatory Commission (NRC), the OECD, and the Nuclear Engineering Program (NEP) of the Pennsylvania State University. The experimental data was produced during a measurement campaign by the NUPEC, Japan, and sponsored by the Japan Ministry of Economy, Trade and Industry (METI). This international benchmark, based on the NUPEC database, encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactor's safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points are kept in mind while the benchmark specification is being established. As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have improved tremendously through the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark consists of two parts (phases), each part consisting of different exercises: - Phase 1 Void Distribution Benchmark: Exercise 1: Steady-state sub
Ruano, Juan; Gómez-García, Francisco; Gay-Mimbrera, Jesús; Aguilar-Luque, Macarena; Fernández-Rueda, José Luis; Fernández-Chaichio, Jesús; Alcalde-Mellado, Patricia; Carmona-Fernandez, Pedro J; Sanz-Cabanillas, Juan Luis; Viguera-Guerra, Isabel; Franco-García, Francisco; Cárdenas-Aranzana, Manuel; Romero, José Luis Hernández; Gonzalez-Padilla, Marcelino; Isla-Tejera, Beatriz; Garcia-Nieto, Antonio Velez
Epidemiology and the reporting characteristics of systematic reviews (SRs) and meta-analyses (MAs) are well known. However, no study has analyzed the influence of protocol features on the probability that a study's results will be finally reported, thereby indirectly assessing the reporting bias of International Prospective Register of Systematic Reviews (PROSPERO) registration records. The objective of this study is to explore which factors are associated with a higher probability that results derived from a non-Cochrane PROSPERO registration record for a systematic review will be finally reported as an original article in a scientific journal. The PROSPERO repository will be web scraped to automatically and iteratively obtain all completed non-Cochrane registration records stored from February 2011 to December 2017. Downloaded records will be screened, and those with less than 90% fulfilled or are duplicated (i.e., those sharing titles and reviewers) will be excluded. Manual and human-supervised automatic methods will be used for data extraction, depending on the data source (fields of PROSPERO registration records, bibliometric databases, etc.). Records will be classified into published, discontinued, and abandoned review subgroups. All articles derived from published reviews will be obtained through multiple parallel searches using the full protocol "title" and/or "list reviewers" in MEDLINE/PubMed databases and Google Scholar. Reviewer, author, article, and journal metadata will be obtained using different sources. R and Python programming and analysis languages will be used to describe the datasets; perform text mining, machine learning, and deep learning analyses; and visualize the data. We will report the study according to the recommendations for meta-epidemiological studies adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for SRs and MAs. This meta-epidemiological study will explore, for the first time
Flores, S. C.; Hill, T. M.; Russell, A. D.; Brooks, G.
We are conducting investigations of calcareous benthic foraminifera acquired from Tomales Bay, California to reconstruct geochemical conditions of the bay for the past ~400 years, a time period of both natural and anthropogenic environmental change. Tomales Bay, located ~50km northwest of San Francisco, is a long (20.4 km), narrow (0.7 - 1.7 km) and shallow (2.0 - 6.0 m) bay that exhibits long-residence times and is stratified in the summer due to seasonal hypersalinity. Tomales Bay is a unique environment for climate and environmental change research because of the wide documented variability in carbonate parameters (pH, alkalinity, DIC) due to freshwater input from terrestrial sources that decreases aragonite and calcite saturation states. The historical record provided by benthic foraminiferal species and geochemistry, sedimentary carbon (TOC and TIC) analyses, and investigations of recent (Rose-Bengal stained) foraminifera are being utilized to constrain 3 major processes: 1) the range of temperature and salinity shifts over the past 400 years, 2) the relative dominance of marine- vs. fresh-water sources to the bay, and 3) the extent to which freshwater input and runoff may influence water chemistry (saturation state, Ω) with impacts on foraminiferal calcification. Four sediment cores were acquired in 2009 and 2010, and subsequently age-dated utilizing radiocarbon analyses (seven samples). Results indicate an increase in preservation of agglutinated versus calcareous foraminiferal tests (shells) since the mid-1900’s, and greater abundances of agglutinated tests found near freshwater sources. The major calcareous foraminifera present in the record include Elphidium hannai, Elphidium excavatum, Ammonia tepida, and Buccella frigida. Results from oxygen and carbon stable isotope analyses as well as total organic carbon (by weight) for all the cores will also be presented. These results will be compared to modern observations and instrumental records of
Full Text Available Abstract Background The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR for district hospitals as a means of improving documentation of illness. Methods The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163 and from a 60% random sample of dates after intervention (n = 705 were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR. Results The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months. Conclusion The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines.
The third workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-3) was held from 26 to 27 April 2006 in Pisa Italy. This international benchmark encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models for the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach applicable to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction are currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is composed of two parts (phases), each part consisting of different exercises: - Phase I Void Distribution Benchmark: Exercise 1 (I-1): Steady-state sub-channel grade benchmark; Exercise 2 (I-2): Steady-state microscopic grade benchmark; Exercise 3 (I-3): Transient macroscopic grade benchmark; Exercise 4 (I-4): Uncertainty analysis of the steady state sub-channel benchmark. - Phase II Critical Power Benchmark: Exercise 0 (II-0): Pressure drop benchmark; Exercise 1 (II-1): Steady-state benchmark; Exercise 2 (II-2): Transient benchmark; Exercise 3 (II-3): Uncertainty Analysis
The Sixth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-6) was held on April 27-28 2009 in University Park / State College, PA, USA. This international benchmark encourages advancement in the un-investigated fields of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: Phase I - Void Distribution Benchmark: Exercise 1 (I-1) - Steady-state sub-channel grade benchmark; Exercise 2 (I-2) - Steady-state microscopic grade benchmark; Exercise 3 (I-3) - Transient macroscopic grade benchmark; Exercise 4 (I-4) - Uncertainty analysis of the steady state sub-channel benchmark. Phase II - Critical Power Benchmark: Exercise 0 (II-0) - Pressure drop benchmark; Exercise 1 (II-1) - Steady-state benchmark; Exercise 2 (II-2) - Transient benchmark
The fourth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-4) was held on 8 and 9 May 2007 at NEA Headquarters, Issy-les-Moulineaux, France. This international benchmark encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved through the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: - Phase I Void Distribution Benchmark: Exercise 1 (I-1): Steady-state sub-channel grade benchmark; Exercise 2 (I-2): Steady-state microscopic grade benchmark; Exercise 3 (I-3): Transient macroscopic grade benchmark; Exercise 4 (I-4): Uncertainty analysis of the steady state sub-channel benchmark. - Phase II Critical Power Benchmark: Exercise 0 (II-0): Pressure drop benchmark; Exercise 1 (II-1): Steady-state benchmark; Exercise 2 (II-2): Transient benchmark
The fifth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-5) was held on 31 March and 1 April 2008 in Garching, Germany. This international benchmark encourages advancement in the un-investigated fields of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: - Phase I - Void Distribution Benchmark: Exercise 1 (I-1) - Steady-state sub-channel grade benchmark; Exercise 2 (I-2) - Steady-state microscopic grade benchmark; Exercise 3 (I-3) - Transient macroscopic grade benchmark; Exercise 4 (I-4) - Uncertainty analysis of the steady state sub-channel benchmark. - Phase II - Critical Power Benchmark: Exercise 0 (II-0) - Pressure drop benchmark; Exercise 1 (II-1) - Steady-state benchmark; Exercise 2 (II-2) - Transient benchmark; Exercise 3
The second workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-2) was held on 27-29 of June 2005 in University Park, PA, USA. This international benchmark, based on the NUPEC database, encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind when establishing the benchmark specification. As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark consists of two parts (phases), each part consisting of different exercises: - Phase 1 Void Distribution Benchmark: Exercise 1: Steady-state sub-channel grade benchmark; Exercise 2: Steady-state microscopic grade benchmark; Exercise 3: Transient macroscopic grade benchmark. - Phase 2 Critical Power Benchmark: Exercise 1: Steady-state benchmark; Exercise 2: Transient benchmark. It should be recognized that the purpose of this benchmark is not only the comparison of currently available macroscopic approaches but above-all the
JUAN DAVID VELÁSQUEZ HENAO
Full Text Available La combinación de modelos SARIMA y redes neuronales son una aproximación común para pronosticar series de tiempo no lineales. Mientras la metodología SARIMA es usada para capturar las componentes lineales en la serie de tiempo, las redes neuronales artiﬁ ciales son aplicadas para pronosticar las no-linealidades remanentes en los residuos del modelo SARIMA. En este artículo, se propone un modelo simple no lineal para el pronóstico de series de tiempo obtenido por la combinación de un modelo SARIMA y una neurona simple multiplicativa que usa las mismas entradas del modelo SARIMA. Para evaluar la capacidad de la nueva aproximación, la demanda mensual de electricidad en el mercado de energía de Colombia es pronosticada y comparada con los modelos SARIMA y la neurona simple multiplicativa.
Iolov, Alexandre; Ditlevsen, Susanne; Longtin, Andrë
stimulation of a neuron to achieve a target spike train under the physiological constraint to not damage tissue. Approach. We pose a stochastic optimal control problem to precisely specify the spike times in a leaky integrate-and-fire (LIF) model of a neuron with noise assumed to be of intrinsic or synaptic...... origin. In particular, we allow for the noise to be of arbitrary intensity. The optimal control problem is solved using dynamic programming when the controller has access to the voltage (closed-loop control), and using a maximum principle for the transition density when the controller only has access...... to the spike times (open-loop control). Main results. We have developed a stochastic optimal control algorithm to obtain precise spike times. It is applicable in both the supra-threshold and sub-threshold regimes, under open-loop and closed-loop conditions and with an arbitrary noise intensity; the accuracy...
Koudstaal, Stefan; Pujades-Rodriguez, Mar; Denaxas, Spiros; Gho, Johannes M I H; Shah, Anoop D; Yu, Ning; Patel, Riyaz S; Gale, Chris P; Hoes, Arno W; Cleland, John G; Asselbergs, Folkert W; Hemingway, Harry
The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts. This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age- and sex-matched general population. In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients. NCT02551016. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Fitzgerald, J. W.
Camera system provides accurate photographic recording during acceleration of centrifuge and permits immediate observation of dynamic changes in retinal circulation by a closed-circuit television loop. System consists of main camera, remote control unit, and strobe power supply unit, and is used for fluorescein studies and dynamometry sequences.
A lot of statisticians, actuarial mathematicians, reliability engineers, meteorologists, hydrologists, economists. Business and sport analysts deal with records which play important roles in various fields of statistics and its application. This book enables a reader to check his/her level of understanding of the theory of record values. We give basic formulae which are more important in the theory and present a lot of examples which illustrate the theoretical statements. For a beginner in record statistics, as well as for graduate students the study of our book needs the basic knowledge of the subject. A more advanced reader can use our book to polish his/her knowledge. An upgraded list of bibliography which will help a reader to enrich his/her theoretical knowledge and widen the experience of dealing with ordered observations, is also given in the book.
Lin, K J; Schneeweiss, S
Health insurance claims and electronic health records (EHR) databases have been considered the preferred data sources with which to study drug safety and effectiveness in routine care. Linking claims data to EHR allows researchers to leverage the complementary advantages of each data source to enhance study validity. We propose a framework to evaluate the need for supplementing claims data with EHR and vice versa to optimize outcome ascertainment, exposure assessment, and confounding adjustment. © 2016 American Society for Clinical Pharmacology and Therapeutics.
Perchoux, Camille; Kestens, Yan; Thomas, Frédérique; Van Hulst, Andraea; Thierry, Benoit; Chaix, Basile
Prior epidemiological studies have mainly focused on local residential neighborhoods to assess environmental exposures. However, individual spatial behavior may modify residential neighborhood influences, with weaker health effects expected for mobile populations. By examining individual patterns of daily mobility and associated socio-demographic profiles and transportation modes, this article seeks to develop innovative methods to account for daily mobility in health studies. We used data from the RECORD Cohort Study collected in 2011-2012 in the Paris metropolitan area, France. A sample of 2062 individuals was investigated. Participants' perceived residential neighborhood boundaries and regular activity locations were geocoded using the VERITAS application. Twenty-four indicators were created to qualify individual space-time patterns, using spatial analysis methods and a geographic information system. Three domains of indicators were considered: lifestyle indicators, indicators related to the geometry of the activity space, and indicators related to the importance of the residential neighborhood in the overall activity space. Principal component analysis was used to identify main dimensions of spatial behavior. Multilevel linear regression was used to determine which individual characteristics were associated with each spatial behavior dimension. The factor analysis generated five dimensions of spatial behavior: importance of the residential neighborhood in the activity space, volume of activities, and size, eccentricity, and specialization of the activity space. Age, socioeconomic status, and location of the household in the region were the main predictors of daily mobility patterns. Activity spaces of small sizes centered on the residential neighborhood and implying a large volume of activities were associated with walking and/or biking as a transportation mode. Examination of patterns of spatial behavior by individual socio-demographic characteristics and in
Rong, X.; He, B.; Zhuang, L.
The existing interior decoration of Qing Dynasty is the master of that of each dynasty, with its diversified forms and complicated functions. As early as 1920s, the Rehabilitation Committee of Qing court recorded the interior furnishing in the Forbidden City by using Chinese traditional documentary method. Today, along with the constantly updated techniques, the recording method for the current situation of interior decoration has gradually developed from two-dimensional drawings into digital and comprehensive record. However, the current research results are mostly limited to a single field. This paper takes the digital record and reproduction about the current situation of interior decoration in Jingfu Palace in the Forbidden City as an example. Through the use of photogrammetry, 3D laser scanning, virtual display and other technology and equipment at the forefront of architectural field, it makes qualitative and quantitative record about the interior decoration inside Jingfu Palace. By combing with the interpretation of historical documents, it restores the original design ideas hidden behind the current situation of interior decoration, so as to summarize the best recording and reproducing method of interior decoration of Qing Dynasty.
Full Text Available The existing interior decoration of Qing Dynasty is the master of that of each dynasty, with its diversified forms and complicated functions. As early as 1920s, the Rehabilitation Committee of Qing court recorded the interior furnishing in the Forbidden City by using Chinese traditional documentary method. Today, along with the constantly updated techniques, the recording method for the current situation of interior decoration has gradually developed from two-dimensional drawings into digital and comprehensive record. However, the current research results are mostly limited to a single field. This paper takes the digital record and reproduction about the current situation of interior decoration in Jingfu Palace in the Forbidden City as an example. Through the use of photogrammetry, 3D laser scanning, virtual display and other technology and equipment at the forefront of architectural field, it makes qualitative and quantitative record about the interior decoration inside Jingfu Palace. By combing with the interpretation of historical documents, it restores the original design ideas hidden behind the current situation of interior decoration, so as to summarize the best recording and reproducing method of interior decoration of Qing Dynasty.
Elfman, M.; Limburg, K.E.; Kristiansson, P.; Svedaeng, H.; Westin, L.; Wickstroem, H.; Malmqvist, K.; Pallon, J.
Diadromous fishes - species that move across salinity gradients as part of their life repertoire - form a major part of coastal and inland fisheries. Conventional mark-recapture techniques have long been used to track their movements, but give incomplete information at best. On the other hand, otoliths (ear-stones) of fishes can provide a complete record of major life history events, as reflected both in their microstructure and elemental composition. Strontium, which substitutes for calcium in the aragonite matrix of otoliths, is a powerful tracer of salinity histories in many migratory fishes. We measured Sr and Ca with a nuclear microprobe (PIXE) and show examples (eel, Anguilla anguilla; brown trout, Salmo trutta; American shad, Alosa sapidissima) of how the technique has solved several mysteries within fisheries biology
M. S. Abubakar
Full Text Available Farm records are mostly manually kept on paper notebooks and folders where similar records are organized in one folder or spread sheet. These records are usually kept for many years therefore they becomes bulky and less organized. Consequently, it becomes difficult to search, update and tedious and time consuming to manage these records. This study was carried-out to overcome these problems associated with manual farm records keeping by developing user-friendly, easily accessible, reliable and secured software. The software was limited records keeping in crop production, livestock production, poultry production, employees, income and expenditure. The system was implemented using Java Server Faces (JSF for designing Graphical User Interface (GUI, Enterprises Java Beans (EJB for logic tier and MySQL database for storing farm records.
Birken, Catherine S; Tu, Karen; Oud, William; Carsley, Sarah; Hanna, Miranda; Lebovic, Gerald; Guttmann, Astrid
To determine the prevalence of overweight and obese status in children by age, sex, and visit type, using data from EMRALD ® (Electronic Medical Record Administrative data Linked Database). Heights and weights were abstracted for children 0 to 19 years of age who had at least one well-child visit from January 2010 to December 2011. Using the most recent visit, the proportions and 95% CIs of patients defined as overweight and obese were compared by age group, sex, and visit type using the World Health Organization growth reference standards. Ontario. Children 0 to 19 years of age who were rostered to a primary care physician participating in EMRALD and had at least one well-child visit from January 2010 to December 2011. Proportion and 95% CI of children with overweight and obese status by age group; proportion of children with overweight and obese status by sex (with male sex as the referent) within each age group; and proportion of children with overweight and obese status at the most recent well-child visit type compared with other visit types by age group. There were 28 083 well-child visits during this period. For children who attended well-child visits, 84.7% of visits had both a height and weight documented. Obesity rates were significantly higher in 1- to 4-year-olds compared with children younger than 1 (6.1% vs 2.3%; P overweight and obese status were lower using data from well-child visits compared with other visits. Electronic medical records might be useful to conduct population-based surveillance of overweight or obese status in children. Methodologic standards, however, should be developed. Copyright© the College of Family Physicians of Canada.
Treble, Pauline C.; Bradley, Chris; Wood, Anne; Baker, Andy; Jex, Catherine N.; Fairchild, Ian J.; Gagan, Michael K.; Cowley, Joan; Azcurra, Cecilia
We investigated the distinctive shallow sub-surface hydrology of the southwest Western Australia (SWWA) dune calcarenite using observed rainfall and rainfall δ18O; soil moisture, cave drip rate and dripwater δ18O over a six-year period: August 2005-March 2012. A lumped parameter hydrological model is developed to describe water fluxes and drip δ18O. Comparison of observed data and model output allow us to assess the critical non-climatic karst hydrological processes that modify the precipitation δ18O signal and discuss the implications for speleothem paleoclimate records from this cave and those with a similar karst setting. Our findings include evidence of multiple reservoirs, characterised by distinct δ18O values and recharge responses ('low' and 'high' flow sites). Dripwaters exhibit δ18O variations in wet versus dry years at low-flow sites receiving diffuse seepage from the epikarst with an attenuated isotopic composition that approximates mean rainfall. Recharge from high-magnitude rain events is stored in a secondary reservoir which is associated with high-flow dripwater that is 1‰ lower than our monitored low-flow sites (δ18O). One drip site is characterised by mixed-flow behaviour and exhibits a non-linear threshold response after the cessation of drainage from a secondary reservoir following a record dry year (2006). Additionally, our results yield a better understanding of the vadose zone hydrology and dripwater characteristics in Quaternary age dune limestones. We show that flow to our monitored sites is dominated by diffuse flow with inferred transit times of less than one year. Diffuse flow appears to follow vertical preferential paths through the limestone reflecting differences in permeability and deep recharge into the host rock.
Logothetis Nikos K
Full Text Available Abstract Background Information theory is an increasingly popular framework for studying how the brain encodes sensory information. Despite its widespread use for the analysis of spike trains of single neurons and of small neural populations, its application to the analysis of other types of neurophysiological signals (EEGs, LFPs, BOLD has remained relatively limited so far. This is due to the limited-sampling bias which affects calculation of information, to the complexity of the techniques to eliminate the bias, and to the lack of publicly available fast routines for the information analysis of multi-dimensional responses. Results Here we introduce a new C- and Matlab-based information theoretic toolbox, specifically developed for neuroscience data. This toolbox implements a novel computationally-optimized algorithm for estimating many of the main information theoretic quantities and bias correction techniques used in neuroscience applications. We illustrate and test the toolbox in several ways. First, we verify that these algorithms provide accurate and unbiased estimates of the information carried by analog brain signals (i.e. LFPs, EEGs, or BOLD even when using limited amounts of experimental data. This test is important since existing algorithms were so far tested primarily on spike trains. Second, we apply the toolbox to the analysis of EEGs recorded from a subject watching natural movies, and we characterize the electrodes locations, frequencies and signal features carrying the most visual information. Third, we explain how the toolbox can be used to break down the information carried by different features of the neural signal into distinct components reflecting different ways in which correlations between parts of the neural signal contribute to coding. We illustrate this breakdown by analyzing LFPs recorded from primary visual cortex during presentation of naturalistic movies. Conclusion The new toolbox presented here implements fast
Magri, Cesare; Whittingstall, Kevin; Singh, Vanessa; Logothetis, Nikos K; Panzeri, Stefano
Information theory is an increasingly popular framework for studying how the brain encodes sensory information. Despite its widespread use for the analysis of spike trains of single neurons and of small neural populations, its application to the analysis of other types of neurophysiological signals (EEGs, LFPs, BOLD) has remained relatively limited so far. This is due to the limited-sampling bias which affects calculation of information, to the complexity of the techniques to eliminate the bias, and to the lack of publicly available fast routines for the information analysis of multi-dimensional responses. Here we introduce a new C- and Matlab-based information theoretic toolbox, specifically developed for neuroscience data. This toolbox implements a novel computationally-optimized algorithm for estimating many of the main information theoretic quantities and bias correction techniques used in neuroscience applications. We illustrate and test the toolbox in several ways. First, we verify that these algorithms provide accurate and unbiased estimates of the information carried by analog brain signals (i.e. LFPs, EEGs, or BOLD) even when using limited amounts of experimental data. This test is important since existing algorithms were so far tested primarily on spike trains. Second, we apply the toolbox to the analysis of EEGs recorded from a subject watching natural movies, and we characterize the electrodes locations, frequencies and signal features carrying the most visual information. Third, we explain how the toolbox can be used to break down the information carried by different features of the neural signal into distinct components reflecting different ways in which correlations between parts of the neural signal contribute to coding. We illustrate this breakdown by analyzing LFPs recorded from primary visual cortex during presentation of naturalistic movies. The new toolbox presented here implements fast and data-robust computations of the most relevant
Psimoulis, Panos; Houlié, Nicolas; Michel, Clotaire; Meindl, Michael; Rothacher, Markus
High-rate GPS data are today commonly used to supplement seismic data for the Earth surface motions focusing on earthquake characterisation and rupture modelling. Processing of GPS records using Precise Point Positioning (PPP) can provide real-time information of seismic wave propagation, tsunami early-warning and seismic rupture. Most studies have shown differences between the GPS and seismic systems at very long periods (e.g. >100sec) and static displacements. The aim of this study is the assessment of the consistency of GPS and strong-motion records by comparing their respective displacement waveforms for several frequency bands. For this purpose, the records of the GPS (GEONET) and the strong-motion (KiK-net and K-NET) networks corresponding to the Mw9.0 Tohoku 2011 earthquake were analysed. The comparison of the displacement waveforms of collocated (distance<100m) GPS and strong-motion sites show that the consistency between the two datasets depends on the frequency of the excitation. Differences are mainly due to the GPS noise at relatively short-periods (<3-4 s) and the saturation of the strong-motion sensors for relatively long-periods (40-80 s). Furthermore the agreement between the GPS and strong-motion records also depends on the direction of the excitation signal and the distance from the epicentre. In conclusion, velocities and displacements recovered from GPS and strong-motion records are consistent for long-periods (3-100 s), proving that GPS networks can contribute to the real-time estimation of the long-period ground motion map of an earthquake.
Francis, Nick A; Melbye, Hasse; Kelly, Mark J; Cals, Jochen W L; Hopstaken, Rogier M; Coenen, Samuel; Butler, Christopher C
Conflicting data on the diagnostic and prognostic value of auscultation abnormalities may be partly explained by inconsistent use of terminology. To describe general practitioners use of chest auscultation abnormality terms for patients presenting with acute cough across Europe, and to explore the influence of geographic location and case mix on use of these terms. Clinicians recorded whether 'diminished vesicular breathing', 'wheezes', 'crackles' and 'rhonchi' were present in an observational study of adults with acute cough in 13 networks in 12 European countries. We describe the use of these terms overall and by network, and used multilevel logistic regression to explore variation by network, controlling for patients' gender, age, comorbidities, smoking status and symptoms. 2345 patients were included. Wheeze was the auscultation abnormality most frequently recorded (20.6% overall) with wide variation by network (range: 8.3-30.8%). There was similar variation for other auscultation abnormalities. After controlling for patient characteristics, network was a significant predictor of auscultation abnormalities with odds ratios for location effects ranging from 0.37 to 4.46 for any recorded auscultation abnormality, and from 0.25 to 3.14 for rhonchi. There is important variation in recording chest auscultation abnormalities by general practitioners across Europe, which cannot be explained by differences in patient characteristics. There is a need and opportunity for standardization in the detection and classification of lung sounds.
Chirico, G; Cabano, R; Villa, G; Bigogno, A; Ardesi, M; Dioni, E
Alleviating pain in neonates should be the goal of all caregivers. We evaluated whether recorded maternal voices were safe and effective in limiting pain in preterm infants undergoing heel lance procedures in the neonatal intensive care unit of an Italian children's hospital. This prospective, controlled study took place from December 2013 to December 2015. We enrolled 40 preterm infants, born at a 26-34 weeks of gestation, at a corrected gestational age 29-36 weeks and randomised them to listen or not listen to a recording of their mother's voice during a painful, routine heel lance for blood collection. Changes in the infants' Premature Infant Pain Profile, heart rate, oxygen saturation and blood pressure during the procedure were compared by analysis of variance. Possible side effects, of apnoea, bradycardia, seizures and vomiting, were also recorded. Both groups showed a marked increase in PIPP scores and decrease in oxygen saturation during the procedure, but infants in the treatment group had significantly lower PIPP scores (p = 0.00002) and lower decreases in oxygen saturation (p = 0.0283). No significant side effects were observed. Using recorded maternal voices to limit pain in preterm infants undergoing heel lance procedures appeared safe and effective. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Full Text Available Abstract Background The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient’s diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. Purpose of the study The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Materials and method Commercially available and ADA approved Polyether bite registration paste (Ramitec, Poly vinyl siloxane bite registration paste (Jetbite and Zinc oxide eugenol (ZOE bite registration paste (Super bite were used in the study. A stainless steel die was made according to modified American dental Associations (ADA specification no. 19. Each one of the tested materials were manipulated according to manufacturers’ instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus and compared with standard die
Full Text Available Key insights about the neuronal correlates of consciousness have been gained by electrophysiological recording of single neurons from a particular area or by recording of indirect fMRI signals from the whole brain. However, if rapid interaction among neuronal populations in distant cortical areas is essential for consciousness, other methods such as intracranial electrocorticogram (ECoG that can attain both requirements are necessary. Here we report the results of ECoG experiments in three epilepsy patients and one monkey. We used Continuous Flash Suppression to investigate the neuronal activity when ‘invisible’ stimuli broke interocular suppression. We found that widespread activity in the visual cortex preceded up to 1–2 s before subjective reports of detection and that alpha-band activity in the visual cortex induced by the initial flashes predicted how long the suppression was going to last. We will discuss implication of these findings for the neuronal dynamics associated with consciousness.
Tejo, Sampath Kumar; Kumar, Anil G; Kattimani, Vivekanand S; Desai, Priti D; Nalla, Sandeep; Chaitanya K, Krishna
The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient's diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Commercially available and ADA approved Polyether bite registration paste (Ramitec), Poly vinyl siloxane bite registration paste (Jetbite) and Zinc oxide eugenol (ZOE) bite registration paste (Super bite) were used in the study.A stainless steel die was made according to modified American dental Associations (ADA) specification no. 19. Each one of the tested materials were manipulated according to manufacturers' instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus) and compared with standard die measurements made according to ADA specification no.19 to find out the dimensional
Alan Kevin Bourke
Full Text Available Physical activity monitoring algorithms are often developed using conditions that do not represent real-life activities, not developed using the target population, or not labelled to a high enough resolution to capture the true detail of human movement. We have designed a semi-structured supervised laboratory-based activity protocol and an unsupervised free-living activity protocol and recorded 20 older adults performing both protocols while wearing up to 12 body-worn sensors. Subjects’ movements were recorded using synchronised cameras (≥25 fps, both deployed in a laboratory environment to capture the in-lab portion of the protocol and a body-worn camera for out-of-lab activities. Video labelling of the subjects’ movements was performed by five raters using 11 different category labels. The overall level of agreement was high (percentage of agreement >90.05%, and Cohen’s Kappa, corrected kappa, Krippendorff’s alpha and Fleiss’ kappa >0.86. A total of 43.92 h of activities were recorded, including 9.52 h of in-lab and 34.41 h of out-of-lab activities. A total of 88.37% and 152.01% of planned transitions were recorded during the in-lab and out-of-lab scenarios, respectively. This study has produced the most detailed dataset to date of inertial sensor data, synchronised with high frame-rate (≥25 fps video labelled data recorded in a free-living environment from older adults living independently. This dataset is suitable for validation of existing activity classification systems and development of new activity classification algorithms.
Pierre-Cédric B. Crouch
two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations.
Hayward, James; Thomson, Fionagh; Milne, Heather; Buckingham, Susan; Sheikh, Aziz; Fernando, Bernard; Cresswell, Kathrin; Williams, Robin; Pinnock, Hilary
Computerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care. Quantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices. 132 prescriptions were issued in the course of 73 of the consultations, of which 81 (61%) attracted at least one alert. Of the total of 117 alerts, only three resulted in the GP checking, but not altering, the prescription. CDSS provided information and safety alerts at the point of generating a prescription. This was 'too much, too late' as the majority of the 'work' of prescribing occurred prior to using the computer. By the time an alert appeared, the GP had formulated the problem(s), potentially spent several minutes considering, explaining, negotiating, and reaching agreement with the patient about the proposed treatment, and had possibly given instructions and printed an information leaflet. CDSS alerts do not coincide with the prescribing workflow throughout the whole GP consultation. Current systems interrupt to correct decisions that have already been taken, rather than assisting formulation of the management plan. CDSS are likely to be more acceptable and effective if the prescribing support is provided much earlier in the process of generating a prescription.
C. Del Gaudio
Full Text Available The tiltmetric dataset of Phlegraean Fields area showed a discrete correlation with the volcanic dynamics, suggesting that tiltmetric monitoring is important for the surveillance of active volcanic areas. Tilt data recorded in 2006 at 2 stations belonging to the monitoring network of the Osservatorio Vesuviano (INGV, National Institute for Geophysics and Volcanology, Italy in the Phlegraean Fields are discussed in this paper. The acquired signals have shown a strong tiltmetric inversion that took place from the end of July 2006. After correcting tilt variations to eliminate the influence of temperature (influencing 90% of the signal at OLB station, hereafter OLB a significant value of the tilt still remains. This change is related to a local inflation episode lasting 3 months, during an unrest phase that started 2 years before. It is interesting to note that tilt amplitude is much greater at OLB than the slope of the displacement field predicted by the theoretical inflation models, but data show that this field is not homogeneous and in some areas very tilted. Moreover, in the last days before the end of tilt inversion, a low energy seismic swarm happened at about 1 km of distance from the tiltmetric station by hundreds of VT (Volcano-Tectonics and LP (Long-Period events.
Full Text Available Background The effect of health information technology (HIT on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques.Objective To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices.Methods Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members.Results High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients.Conclusion This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.
Franz, D.D.; Kraeger, B.A.; Linsley, R.K.
Knowledge of the return periods of large floods is required to make risk analyses for nuclear power plants subject to flooding from rivers. The system reported here combined the stochastic simulation of hourly rainfall data and daily pan evaporation data with the deterministic simulation of streamflow by using the synthetic rainfall and evaporation data as input to a calibrated rainfall runoff model. The sequence of annual maximum flood peaks from a synthetic record of 10,000 years or more was then analyzed to obtain estimates of flood frequency. The reasonableness of the flood frequency results must be evaluated on the degree of mimicry of the key characteristics of the observed rainfall data and the ability of the rainfall-runoff model to mimic the observed flood frequency during the calibration period. On this basis, the flood frequency results appeared to be a reasonable extrapolation of the data used in defining the model parameters. There is a need to develop regional parameters for the stochastic models and to conduct research on the relationship between the stochastic structure of rainfall and stochastic structure of flood frequency. The methodology is applicable, assuming a highly skilled analyst, to watersheds similar to those already tested
Full Text Available Abstract Background Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically. Findings A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated. Discussion This paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design.
Márquez-Rodas, Iván; López-Trabada, Daniel; Rupérez Blanco, Ana Belén; Custodio Cabello, Sara; Peligros Gómez, María Isabel; Orera Clemente, María; Calvo, Felipe A; Martín, Miguel
Identification of patients at risk of hereditary cancer is an essential component of oncology practice, since it enables clinicians to offer early detection and prevention programs. However, the large number of hereditary syndromes makes it difficult to take them all into account in daily practice. Consequently, the National Cancer Institute (NCI) has suggested a series of criteria to guide initial suspicion. It was the aim of this study to assess the perception of the risk of hereditary cancer according to the NCI criteria in our medical oncology service. We retrospectively analyzed the recordings of the family history in new cancer patients seen in our medical oncology service from January to November 2009, only 1 year before the implementation of our multidisciplinary hereditary cancer program. The family history was recorded in only 175/621 (28%) patients. A total of 119 (19%) patients met 1 or more NCI criteria (1 criterion, n = 91; 2 criteria, n = 23; 3 criteria, n = 4; and 4 criteria, n = 1), and only 14 (11.4%) patients were referred to genetic counseling. This study shows that few clinicians record the family history. The perception of the risk of hereditary cancer is low according to the NCI criteria in our medical oncology service. These findings can be explained by the lack of a multidisciplinary hereditary cancer program when the study was performed. Copyright © 2012 S. Karger AG, Basel.
Hibbert, Peter D; Hallahan, Andrew R; Muething, Stephen E; Lachman, Peter; Hooper, Tamara D; Wiles, Louise K; Jaffe, Adam; White, Les; Wheaton, Gavin R; Runciman, William B; Dalton, Sarah; Williams, Helena M; Braithwaite, Jeffrey
Introduction A high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The aim of this study is to measure the frequency and types of adverse events encountered in Australian paediatric care in a range of healthcare settings. Methods and analysis A form of retrospective medical record review, the Institute of Healthcare Improvement's Global Trigger Tool, will be modified to collect data. Records of children aged <16 years managed during 2012 and 2013 will be reviewed. We aim to review 6000–8000 records from a sample of healthcare practices (hospitals, general practices and specialists). Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Hospital Network in South Australia. An application is under review with the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers. PMID:25854978
Link, M.; Martinek, J.
For nuclear power plants extensive proof of quality is required which has to be documented reliably by quality records. With respect to the paper volume it is the most comprehensive 'curriculum vitae' of the technique. Traditional methods of information and recording are unsatisfactory for meeting regulatory requirements for maintaining the QA-aspects of status reporting, completeness, traceability and retrieval. Therefore KWU has established a record (documentation) subsystem within the overall component qualification system. Examples of the general documentation requirements, the procedure and handling in accordance with this subsystem for mechanical equipment are to be described examplarily. Topics are: - National and international requirements - Definition of QA records - Modular and product orientated KWU-record subsystem - Criteria for developing records - Record control, distribution, collection, storage - New documentation techniques (microfilm, data processing) - Education and training of personnel. (orig./RW)
Przytula, Kamila; Bailey, Stacy Cooper; Galanter, William L; Lambert, Bruce L; Shrestha, Neeha; Dickens, Carolyn; Falck, Suzanne; Wolf, Michael S
The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is 'Tools for Optimizing Medication Safety.' Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the 'Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use'. The overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only). Through this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the
Bobo William V
Full Text Available Abstract Background Diabetic ketoacidosis (DKA is a potentially life-threatening complication of treatment with some atypical antipsychotic drugs in children and youth. Because drug-associated DKA is rare, large automated health outcomes databases may be a valuable data source for conducting pharmacoepidemiologic studies of DKA associated with exposure to individual antipsychotic drugs. However, no validated computer case definition of DKA exists. We sought to assess the positive predictive value (PPV of a computer case definition to detect incident cases of DKA, using automated records of Tennessee Medicaid as the data source and medical record confirmation as a "gold standard." Methods The computer case definition of DKA was developed from a retrospective cohort study of antipsychotic-related type 2 diabetes mellitus (1996-2007 in Tennessee Medicaid enrollees, aged 6-24 years. Thirty potential cases with any DKA diagnosis (ICD-9 250.1, ICD-10 E1x.1 were identified from inpatient encounter claims. Medical records were reviewed to determine if they met the clinical definition of DKA. Results Of 30 potential cases, 27 (90% were successfully abstracted and adjudicated. Of these, 24 cases were confirmed by medical record review (PPV 88.9%, 95% CI 71.9 to 96.1%. Three non-confirmed cases presented acutely with severe hyperglycemia, but had no evidence of acidosis. Conclusions Diabetic ketoacidosis in children and youth can be identified in a computerized Medicaid database using our case definition, which could be useful for automated database studies in which drug-associated DKA is the outcome of interest.
Randi E. Foraker
Full Text Available <3% of Americans have ideal cardiovascular health (CVH. The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013 and compared values to those ascertained at one-year (May–July 2014 among intervention (n = 109 and control (n = 42 patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal and diabetes (62% to 68% ideal, but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population.
Taylor, Stephanie Parks; Ledford, Robert; Palmer, Victoria; Abel, Erika
Increasing attention is being given to the importance of communication in the delivery of high-quality healthcare. We sought to determine whether communication improved in a hospital setting following the introduction of an electronic medical record (EMR). This pre-post cohort design enrolled 75 patient-nurse-physician triads prior to the introduction of EMR, and 123 triads after the introduction of EMR. Nurses and patients reported whether they communicated with the physician that day. Patients, nurses and physicians answered several questions about the plan of care for the day. Responses were scored for degree of agreement and compared between pre-EMR and post-EMR cohorts. The primary outcome was Total Agreement Score, calculated as the sum of the agreement responses. Chart review was performed to determine patients' actual length of stay. Although there was no difference between the frequency of nurses reporting communication with physicians before and after EMR, face-to-face communication was significantly reduced (67% vs 51%, p=0.03). Total Agreement Score was significantly lower after the implementation of EMR (p=0.03). Additionally, fewer patients accurately predicted their expected length of stay after EMR (34% vs 26%, p=0.001). The implementation of EMR was associated with a decrease in face-to-face communication between physicians and nurses, and worsened overall agreement about the plan of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
The implementation of biometrics entails either the establishment of an identity or tracing a person's identity. Biometric passport data (e.g., irises, fingers, faces) can be used in order to verify a passenger's identity. The proposed Passenger Name Record (PNR) system contains all the information necessary to enable reservations to be processed and controlled by the booking and participating air carriers for each journey booked by or on behalf of any person. PNR data are related to travel movements, usually flights, and include passport data, name, address, telephone numbers, travel agent, credit card number, history of changes in the flight schedule, seat preferences, and other information. In the aftermath of the September 11 attacks, a new emergency political-law status of society was established: the continuous state of "war" against the so-called unlawful combatants of the "enemy". Officially, the enemy is the terrorists, but the victims of the privacy invasions caused by the above new form of data processing are the civilians. The data processing based on biometrics is covered both by Directive 95/46 EC and Article 8 of the Convention on the Protection of Human Rights and Fundamental Freedoms (now the European Convention on Human Rights, "ECHR"). According to Article 2, Paragraph a of the above Directive, personal data shall mean any information relating to an identified or identifiable natural person; an identifiable person is one who can be identified, directly or indirectly, in particular by reference to an identification number or to one or more factors specific to his/her physical, physiological, mental, economic, cultural, or social identity.
Full Text Available The implementation of biometrics entails either the establishment of an identity or tracing a person's identity. Biometric passport data (e.g., irises, fingers, faces can be used in order to verify a passenger's identity. The proposed Passenger Name Record (PNR system contains all the information necessary to enable reservations to be processed and controlled by the booking and participating air carriers for each journey booked by or on behalf of any person. PNR data are related to travel movements, usually flights, and include passport data, name, address, telephone numbers, travel agent, credit card number, history of changes in the flight schedule, seat preferences, and other information. In the aftermath of the September 11 attacks, a new emergency political-law status of society was established: the continuous state of “war” against the so-called unlawful combatants of the “enemy”. Officially, the enemy is the terrorists, but the victims of the privacy invasions caused by the above new form of data processing are the civilians. The data processing based on biometrics is covered both by Directive 95/46 EC and Article 8 of the Convention on the Protection of Human Rights and Fundamental Freedoms (now the European Convention on Human Rights, “ECHR”. According to Article 2, Paragraph a of the above Directive, personal data shall mean any information relating to an identified or identifiable natural person; an identifiable person is one who can be identified, directly or indirectly, in particular by reference to an identification number or to one or more factors specific to his/her physical, physiological, mental, economic, cultural, or social identity.
Reid, Caroline H.; Finnerty, Niall J.
We detail an extensive characterisation study on a previously described dual amperometric H2O2 biosensor consisting of H2O2 detection (blank) and degradation (catalase) electrodes. In vitro investigations demonstrated excellent H2O2 sensitivity and selectivity against the interferent, ascorbic acid. Ex vivo studies were performed to mimic physiological conditions prior to in vivo deployment. Exposure to brain tissue homogenate identified reliable sensitivity and selectivity recordings up to seven days for both blank and catalase electrodes. Furthermore, there was no compromise in pre- and post-implanted catalase electrode sensitivity in ex vivo mouse brain. In vivo investigations performed in anaesthetised mice confirmed the ability of the H2O2 biosensor to detect increases in amperometric current following locally perfused/infused H2O2 and antioxidant inhibitors mercaptosuccinic acid and sodium azide. Subsequent recordings in freely moving mice identified negligible effects of control saline and sodium ascorbate interference injections on amperometric H2O2 current. Furthermore, the stability of the amperometric current was confirmed over a five-day period and analysis of 24-h signal recordings identified the absence of diurnal variations in amperometric current. Collectively, these findings confirm the biosensor current responds in vivo to increasing exogenous and endogenous H2O2 and tentatively supports measurement of H2O2 dynamics in freely moving NOD SCID mice. PMID:28698470
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Full Text Available While rheumatoid arthritis is an established risk factor for cardiovascular disease (CVD, our knowledge of how the pattern of risk varies for different cardiovascular phenotypes is incomplete. The association between rheumatoid arthritis and the initial presentation of 12 types of CVDs were examined in a contemporary population of men and women of a wide age range.CALIBER data, which links primary care, hospital and mortality data in England, was analysed. A cohort of people aged ≥18 years and without history of CVD was assembled and included all patients with prospectively recorded rheumatoid arthritis from January 1997, until March 2010, matched with up to ten people without rheumatoid arthritis by age, sex and general practice. The associations between rheumatoid arthritis and the initial presentation of 12 types of CVDs were estimated using multivariable random effects Poisson regression models.The analysis included 12,120 individuals with rheumatoid arthritis and 121,191 comparators. Of these, 2,525 patients with and 18,146 without rheumatoid arthritis developed CVDs during a median of 4.2 years of follow-up. Patients with rheumatoid arthritis had higher rates of myocardial infarction (adjusted incidence ratio [IRR] = 1.43, 95%CI 1.21-1.70, unheralded coronary death (IRR = 1.60, 95%CI 1.18-2.18, heart failure (IRR = 1.61, 95%CI 1.43-1.83, cardiac arrest (HR = 2.26, 95%CI 1.69-3.02 and peripheral arterial disease (HR = 1.36, 95%CI 1.14-1.62; and lower rates of stable angina (HR = 0.83, 95%CI 0.73-0.95. There was no evidence of association with cerebrovascular diseases, abdominal aortic aneurysm or unstable angina, or of interactions with sex or age.The observed associations with some but not all types of CVDs inform both clinical practice and the selection of cardiovascular endpoints for trials and for the development of prognostic models for patients with rheumatoid arthritis.